In United States legislation, and are companion
bipartisan
Bipartisanship, sometimes referred to as nonpartisanship, is a political situation, usually in the context of a two-party system (especially those of the United States and some other western countries), in which opposing political parties find co ...
bill
Bill(s) may refer to:
Common meanings
* Banknote, paper cash (especially in the United States)
* Bill (law), a proposed law put before a legislature
* Invoice, commercial document issued by a seller to a buyer
* Bill, a bird or animal's beak
Plac ...
s that eliminate prompt pay discounts from the calculation of Average Sales Price (ASP), which is the basis for
Medicare drug reimbursement rates for community cancer clinics. S. 1221 was introduced by Senators
Arlen Specter
Arlen Specter (February 12, 1930 – October 14, 2012) was an American lawyer, author and politician who served as a United States Senator from Pennsylvania from 1981 to 2011. Specter was a Democrat from 1951 to 1965, then a Republican fr ...
(D-PA) and
Pat Roberts
Charles Patrick Roberts (born April 20, 1936) is a retired American politician and journalist who served as a United States senator from Kansas from 1997 to 2021. A member of the Republican Party, Roberts served 8 terms in the U.S. House of Rep ...
(R-KS).
H.R. 1392 was introduced by Representatives
Gene Green (D-TX),
Ed Whitfield
Wayne Edward Whitfield (born May 25, 1943) is an American politician and attorney who served as the U.S. representative of from January 1995, until his resignation in September 2016. He is a member of the Republican Party, and the first to repr ...
(R-KY),
Mike Ross (D-AR),
Ed Towns
Edolphus "Ed" Towns Jr. (born July 21, 1934) is an American politician who served in the United States House of Representatives from 1983 to 2013. A Democrat from New York, Towns was Chairman of the House Oversight and Government Reform Committe ...
(D-NY),
Diana DeGette
Diana Louise DeGette (; born July 29, 1957) is an American lawyer and politician serving as the U.S. representative for since 1997. A member of the Democratic Party, her district is based in Denver. DeGette was a Chief Deputy Whip from 2005 ...
(D-CO),
Mike Rogers (R-MI),
Betty Sutton
Betty Sue Sutton (born July 31, 1963) is an American politician who currently serves as a Judge of Ohio's 9th District Court of Appeals. She previously served as a U.S. Representative for from 2007 to 2013. She is a member of the Democratic Party ...
(D-OH),
Bart Gordon
Barton Jennings Gordon (born January 24, 1949) is an American politician and former U.S. Representative for , serving from 1985 until 2011. The district includes several rural areas and fast-growing suburbs east of Nashville. He was Chairman of ...
(D-TN),
Lee Terry
Lee Raymond Terry (born January 29, 1962) is a former American politician and a senior law firm adviser. From 1999 to 2015, he served as a member of the U.S. House of Representatives for as a member of the Republican Party. Since 2015, Terry ...
(R-NE) and
Ralph Hall
Ralph Moody Hall (May 3, 1923 – March 7, 2019) was an American politician who served as the United States representative for from 1981 to 2015. He was first elected in 1980, and was the chairman of the House Committee on Science, Space and Tec ...
(R-TX) and has close to 50 cosponsors.
S.1221 and H.R. 1392 will amend title XVIII of the
Social Security Act to ensure more appropriate payment amounts for drugs and biologicals under Part B of the Medicare Program by excluding customary prompt pay discounts extended to wholesalers from the manufacturer's Average Sales Price (ASP). Prompt pay discounts are provided by
pharmaceutical
A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field an ...
manufacturers to drug distributors.
Because they are financing terms between manufacturers and distributors, prompt pay discounts are not passed on to community cancer clinics. However, the
Medicare Modernization Act of 2003 (MMA) required that prompt pay discounts be included in the calculation of ASP. Their inclusion artificially reduces Medicare reimbursement rates by approximately 2%.
Currently the prompt pay discounts artificially reduce Medicare Part B drug reimbursement rates for community oncology clinics, jeopardizing the viability of these providers. Additionally, prompt pay discounts also reduce the payment rates of private payers that use ASP. The bill is a step forward in addressing problems with Medicare reimbursement for cancer drugs.
Excluding distributor prompt pay discounts from the ASP methodology is consistent with existing policy and will create greater uniformity among federal healthcare programs, as these terms already are excluded from the Medicaid Average Manufacturer Price (AMP) methodology.
Healthcare reform legislation in the United States
Medicare and Medicaid (United States)
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