Important Update: Changes to Medication Delivery
The Government is Stopping Us from Delivering Your Drugs. What You Can Do.
We have an important update regarding the delivery of your oral medications (pills). The government has implemented a new ruling that affects how we provide your prescription drugs.
Here is what you need to know:
- A recent decision by the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare, says we can no longer mail or deliver patient medications.
- Patients are now required to personally visit the clinic to pick up all medications. Even friends and family members cannot pick them up for you.
- This change is based on a bad interpretation of an old law against doctors from having conflicts of interest. But it makes no sense that us dispensing medication directly is any different than us dispensing it through the mail.
- Forcing patients to travel to our clinic for every prescription risks disrupting or stopping the care of our sick patients, especially seniors who may not drive, have difficulty with transportation, or live in rural areas.
- The government says patients who can’t travel can get their prescriptions from big corporations called pharmacy benefit managers (PBMs). But PBMs often delay or deny care!
- We are working with the Community Oncology Alliance (COA) to overturn this decision. It puts patients at risk and was also made without following the law for such a large change.
Please consider contacting your Member of Congress and ask them to help fix this change. You can quickly send a message to them online using this link: https://p2a.co/czLHSal.
Why is CMS Stopping Medicare Patients’ Access to Cancer Drugs?
In 2021, the Centers for Medicare & Medicaid Services (CMS) published a Frequently Asked Questions document (FAQ) that impedes Medicare and Medicaid beneficiaries with cancer (as well as with other serious diseases) from getting their oral chemotherapy and related oral cancer medications from their oncologists.
CMS’ FAQ says that a medical practice, such as an oncology or urology practice treating cancer patients, would violate the federal law (known as the Stark law) if it offered patients the convenience of receiving their prescription drugs by mail, FedEx, courier, or any other means and did not require the patient to personally pick up the prescription from the practice site. CMS’ interpretation prohibits a spouse or caregiver from picking up a patient’s drug(s) from the patient’s medical practice.
The CMS FAQ places a terrible inconvenience and burden on Medicare seniors and disabled beneficiaries, as well as Medicaid patients, in getting access to their potentially life-saving medications. Medical practices engaged in delivering drugsto their patients have been operating under a waiver of the Stark law during the public health emergency (PHE). However, with the PHE ending on May 11, 2023, CMS doubled down in a new FAQ that they had not changed their ruling. In fact, and worse yet, CMS said that patients needing to get their medications in the mail could do so through mail order pharmacies operated by pharmacy benefit managers (PBMs), which are known to delay and even deny critical drugs to patients.
This new FAQ may not just stop Medicare and Medicaid patients from getting their cancer drugs and other medications, but also all patients. PBMs may say that medical practices are not compliant with the Stark law as a result of the latest FAQ and thus deny access or terminate practices from PBM networks, as well as mandating that patients use their mail order pharmacies.
Oral drugs are dispensed to specific patients. This is different than drugs that are subsequently delivered to patients as a convenience or medical necessity – for example, the patient is too sick from cancer, so they can’t pick the drug up personally – or does not have access to transportation, a problem in rural areas. This is why this is clearly not a Stark violation. CMS is wrong.
Finally, CMS is actually violating a law (the Administrative Procedure Act) that requires all government agencies to allow stakeholders, like patients and their doctors, to comment on important changes like this one.
We understand the concerns this decision is causing patients and assure you that we are actively working to address it. Thank you for your continued trust and support.