Thousands of small physician offices are "getting out of the business of administering drugs for conditions ranging from anemia and cancer to arthritis and infections," the Wall Street Journal reports. The shift is "an unintended consequence of a change in the way Medicare reimburses doctors" to administer medications that are injected or infused, according to the Journal.

Companies that manufacture the medications, such as Amgen and Johnson & Johnson, offer large rebates or discounts for bulk purchases, but many smaller physician offices do not purchase such treatments in bulk. In addition, because Medicare determines the reimbursements for such medications based on the average price paid, the discounts reduce reimbursements for all physicians, regardless of whether they receive discounts.

Acting CMS Administrator Leslie Norwalk said that physicians who cannot afford the medications can enroll in a federal program called the Competitive Acquisition Program, which allows physicians to order treatments directly from companies and bill Medicare for the costs. However, most of the oncology community considers the program "impractical and unworkable" because of the large amount of paperwork involved, according to Frederick Schnell, president of the Community Oncology Alliance.

The group supports passage of the Community Cancer Care Preservation Act (HR 1190), a bill introduced in February that would exclude some discounts from the formula that Medicare uses to determine the reimbursements for such medications (Johnson/Won Tesoriero, Wall Street Journal, 5/25).

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