Community Cancer and Congress Reps Meet on 'Virtual Hill'

Roxanne Nelson, RN, BSN

May 21, 2021

The Association of Community Cancer Centers (ACCC) recently hosted a Virtual Hill Day, which allowed members to meet with Congressional representatives without having to travel to DC. Their goal was to share "front-line" stories of delivering care during the COVID-19 pandemic, as well as discussing legislative action to ensure equitable patient access to quality cancer care.

In particular, the ACCC members focused on encouraging support for two recently introduced bills: the Telehealth Modernization Act and the Safe Step Act. These bills can directly impact access to timely and quality cancer care for patients across the country.

A total of 43 members of ACCC, representing physicians, pharmacists, administrators, financial advocates, nurses, mental health professionals, and others, attended over 70 virtual meetings in 24 states.

These participants also addressed other legislative priorities that affect cancer care including the Access to Genetic Counselor Services Act, the Research Investment to Spark the Economy (RISE) Act, and the Medicare Multi-Cancer Early Detection Screening Coverage Act of 2021.

"This is a pivotal point in time for the oncology community. The pandemic shined a spotlight on shortcomings in our healthcare system, including health inequities and lack of access for rural patients," commented Olalekan Ajayi, PharmD, MBA, secretary, Association of Community Cancer Centers and director of practice transformation, Sheridan Memorial Hospital, Wyoming.

"We must take advantage of this ongoing discussion to shift federal policies forward to improve patient outcomes," Ajayi said in a statement.

Removing Restrictions on Telehealth

The Telehealth Modernization Act (H.R. 1332/S.368) focuses on extending flexibilities for telehealth that were authorized during the public health emergency brought on by the COVID-19 pandemic. The bill modifies requirements relating to coverage of telehealth services for Medicare recipients.

Before the pandemic, telehealth services were largely nonreimbursable, and were restricted to use by patients living in remote and rural areas who had existing relationships with a medical provider. New policies enacted in response to the pandemic have enabled providers to offer telehealth services to patients living outside of designated rural areas and across state lines from their providers.

The bill specifically extends certain flexibilities that were initially authorized during the COVID-19 pandemic. Among other things, it permanently removes Medicare's geographic and originating site restrictions, and allows all types of practitioners to deliver telehealth services, as determined by the Centers for Medicare & Medicaid Services (CMS).

A bipartisan bill, it was introduced by Representatives Earl L. "Buddy" Carter (R-Ga) and Lisa Blunt Rochester (D-De) in the House and by Senators Tim Scott (R-SC), Brian Schatz (D-HI), and Jeanne Shaheen (D-NH) in the Senate. 

Exceptions to Steps

Step therapy is a managed care approach that some insurers use to cut costs, and it is often referred to as "fail first," since it requires patients to try lower cost treatments before authorization will be given for a more expensive medication. As patients with cancer generally require complex treatment care plans that can change often, and sometimes several times, as new therapies become available, the ACCC believes that the use of step therapy for people with cancer is inappropriate and creates barriers to appropriate, necessary, and timely care.

The Safe Step Act (H.R. 2163/S.464) amends the Employee Retirement Income Security Act (ERISA) to require a group health plan to provide an exception process for any medication step therapy protocol. The bill establishes a clear exemption process and requires insurers to implement a clear and transparent process for a patient or physician to request an exception to a step therapy protocol.

The Safe Step Act requires that a group health plan grant an exemption if an application clearly demonstrates any of the following situations:

  • A patient already tried and failed on the required drug.

  • Delayed treatment will cause irreversible consequences.

  • The treatment is contraindicated or has caused/is likely to cause an adverse reaction.

  • The required drug will prevent a patient from working or fulfilling activities of daily living.

  • The patient is already stable on the prescription drug selected by the provider, and that drug has been covered by a previous or current insurance plan.

The bill was introduced by representatives Raul Ruiz, MD (D-CA), Brad Wenstrup, DPM (OH-02), Lucy McBath (GA-06), and Mariannette Miller-Meeks, MD (IA-02), who joined Congressman Ruiz in introducing the legislation in the House. Senators Lisa Murkowski (R-AK), Maggie Hassan (D-NH), Bill Cassidy, MD (R-LA), and Jacky Rosen (D-NV) introduced the companion bill in the Senate.

"As a physician, I took an oath to put patients first. The Safe Step does exactly that," said Ruiz in a statement. "It is not safe or fair for patients to be forced to use medications that don't work for them simply because of insurance companies' protocols that do not take the patient's unique health needs into account."

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