IRA Fix Needed to Protect Community Oncology: Nicolas Ferreyros

Starting in 2029, community oncology practices will face a 50% to 60% cut in add-on payments for infused drugs, Nicolas Ferreyros, managing director of the Community Oncology Alliance (COA), said at the Patient-Centered Oncology Care annual conference in Nashville, Tennessee.

Part B Fix Targets Inflation Reduction Act Fallout

The cuts stem from Medicare drug price negotiation under the Inflation Reduction Act (IRA). The Protecting Patient Access to Cancer and Complex Therapies Act would correct what Ferreyros called an unintended consequence of the law.

“Community oncology practices have described this as a practice-ending event.”

Those payments fund operations not otherwise reimbursed under the physician fee schedule, he said.

Ferreyros identified the 2027 hospital outpatient payment rule as the most consequential 340B change. It would lower hospital 340B reimbursement toward acquisition costs, which he said would level the playing field. He tied the gap between acquisition costs and payments to years of hospital acquisitions of community practices.

Insurer Pledges Draw Skepticism

COA is taking a “trust but verify” approach to insurers’ 2025 prior authorization pledges, Ferreyros said. Because the reforms are voluntary, he has seen no meaningful improvement for oncology patients. COA is looking to legislation on prior authorization, step therapy, and utilization management. He expects Congress to turn to insurers and hospitals in the coming years, after passing pharmacy benefit manager reform.

A COA study with Flatiron Health found that community oncology practices deliver survival outcomes as good as or better than benchmarks. COA is sharing the findings with employers and purchasers, urging them to make community practices a preferred site of service. It plans to study additional cancers.

Ferreyros said the IRA remains COA’s top concern. Community oncology provides most cancer care in the United States, and losing that site of service would limit access close to home and affect overall health care spending.