June 1, 2020
Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services
Re: CMS-1744-IFC: Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency
Dear Administrator Verma:
Thank you for your efforts to help our nation respond to and resolve the COVID-19 emergency. I am writing on behalf of Susan G. Komen to comment on CMS-1744-IFC, which announced policy and regulatory revisions in response to the COVID-19 emergency. Komen is the world’s leading nonprofit breast cancer organization representing the millions of women and men who have been diagnosed with breast cancer. Komen has an unmatched, comprehensive 360-degree approach to fighting this disease across all fronts—we advocate for patients, drive research breakthroughs, improve access to high quality care, offer direct patient support and empower people with trustworthy information. Komen is committed to supporting those affected by breast cancer today, while tirelessly searching for tomorrow’s cures. We advocate on behalf of the estimated 279,100 women and men in the United States who will be diagnosed with breast cancer and the more than 42,690 who will die from the disease in 2020 alone.
We appreciate the COVID-19 related policies that you have already enacted and other rules and guidances to help our nation’s families and health care providers adjust to these difficult times. For example:
We support the policies included in CMS-1744-IFC to facilitate access to health care services provided by telemedicine. Breast cancer patients and providers have noted value in telemedicine visits –allowing patients to be contacted via phone or video apps using secure links–ensuring continued access to care during the COVID-19 emergency. This allows patients to only go to the hospital or clinic when absolutely necessary, minimizing points of physical contact between them and health care sites and reducing the risk of transmission of COVID-19 to already-vulnerable populations. We were also pleased to see that CMS recently acted to increase payment for audio-only telemedicine, a critical change for some older Americans with limited access to technology.
One additional need we have heard from providers is their desire for expanded options for those patients where English is not their preferred language. Traditionally, in-person visits have sophisticated systems in place with translators involved in appointments, but that can be difficult in the virtual setting.
We ask that you allow telemedicine to remain expanded post-COVID, to create additional ways for patients and their providers to communicate. Breast cancer patients who are now able to utilize telemedicine for some appointments have conveyed to Komen their relief at not having to leave their home when they are immunocompromised or at increased risk for illnesses that expand far beyond COVID-19.
Likewise, we appreciate that the CMS-1744-IFC also includes policies that facilitate home infusion. While the practicalities of cancer care in the home setting can be challenging for both patients and the providers administering chemotherapy at home, we recognize that some people may be able to work with their physician to transition from therapies administered at the hospital or clinic to infusions administered at home. Komen supports allowing decisions about treatment settings to continue to be made by patients and their providers. Komen seeks to ensure that all patients can access the treatments prescribed by their physician and appreciate the flexibility that the interim final rule is providing to help meet this goal.
As you develop further COVID-19-related policies in the coming weeks, we suggest additional policies for your consideration that will ensure breast cancer patients, survivors and their co-survivors are protected:
- Implement Chemotherapy Parity in Private Insurance and Medicare
Beyond home infusion, implementation of chemotherapy parity would significantly assist cancer patients in maintaining their treatment regimens while staying home. Cancer patients are particularly vulnerable to COVID-19 having compromised immune systems and providers are encouraging some of their patients to stay home as much as possible. When medically appropriate, providers are also transitioning patients to oral or self-administered forms of chemotherapy rather than intravenous chemotherapy administered in a healthcare facility. Unfortunately, due to antiquated insurance benefit design, the switch from an IV to an oral form of the same treatment could lead to patients having a significant cost-sharing burden, precisely at a time when many Americans are experiencing economic hardship. Implementing this policy solution will benefit millions of Americans with cancer and their families, as well as the oncology medical professionals who treat them. Komen advocates for this policy change both in the private insurance market and for Medicare beneficiaries, who will face higher out-of-pocket costs if a drug is covered under Part D rather than Part B.
- Spreading Costs for Part D Drugs
As noted above, costs are often high for cancer treatments covered under Medicare Part D. We applaud recent policy changes that allow individuals to get up to a 90-day supply of drugs under Part D, so they can maintain their treatment regimens while limiting their trips to the pharmacy. However, paying the cost-sharing associated with 90 days of treatment is difficult for many Medicare beneficiaries, who are on fixed incomes. To ensure that people can afford treatment, please require Medicare Part D plans to allow patients to pay more slowly, over time if requested.
- Open Healthcare.gov Enrollment
Komen has joined many others in the patient advocacy community to ask you to initiate a special enrollment period for the healthcare.gov marketplace in the wake of the COVID-19 pandemic. Creating a 60-day special enrollment period and undertaking an educational campaign to ensure the public is aware of the special enrollment period will go a long way toward ensuring individuals can access health insurance. Eleven states and D.C. have taken the initiative to create special enrollment periods, allowing thousands in urgent need of coverage to enroll. You can provide this same option for the millions of Americans who live in the rest of the country. Where you live should not determine your ability to access health care, especially during a national crisis.
Komen thanks you for your leadership and your efforts to respond to the effects of COVID-19. We encourage you to pursue additional policy options to protect breast cancer patients, survivors and co-survivors. We look forward to working with you throughout this process. If you have any questions please do not hesitate to reach out to Molly Guthrie, Director of Public Policy and Advocacy, at email@example.com.
Victoria A.M. Wolodzko
Senior Vice President, Mission
Susan G. Komen