LUGPA Policy Brief - Protecting Patient Access to Cancer and Complex Therapies Act

July 11, 2025 

The Protecting Patient Access to Cancer and Complex Therapies Act, recently re-introduced in the current Congress by Representatives Greg Murphy, M.D. (R-NC), Adam Gray (D-CA), and Neal Dunn, M.D. (R-FL), is a vital bipartisan measure aimed at protecting Medicare beneficiaries’ access to physician-administered therapies for cancer and other complex conditions—including those frequently treated in urology.

LUGPA strongly supports this legislation, which maintains the delicate balance between keeping drug prices affordable for patients and ensuring continued access to life-saving treatments in independent, community-based settings.

This marks a pivotal moment for LUGPA, achieved through our unwavering advocacy and strategic efforts on Capitol Hill. Following more than two years of bipartisan groundwork, particularly with key Democratic leaders, we celebrate the introduction of this crucial legislation, which has garnered support across party lines. The bill directly addresses the unintended reimbursement challenges created by the Inflation Reduction Act (IRA) and supports the long-term sustainability of community-based urology practices.

The IRA granted the Department of Health and Human Services (HHS) the authority to negotiate prices for high-cost Medicare Part B drugs. While the goal is to reduce patient costs, the policy has the unintended consequence of significantly reducing physician reimbursement under the Average Sales Price (ASP) + 6% payment model (reduced to 4.3% due to sequestration).

Because physician payment is directly tied to the drug’s price, a negotiated reduction of 50%, as projected by the Congressional Budget Office (CBO), would halve the add-on payment. For instance, a $10,000 drug currently provides a $600 add-on; if reduced to $5,000, the payment drops to $300. This shift makes it economically unsustainable for independent practices to administer these therapies in-office, threatening patient access and potentially forcing care into higher-cost hospital settings.

Key Provisions of the Bill

The Protecting Patient Access to Cancer and Complex Therapies Act would:

• Preserve ASP+6% Reimbursement
  Maintains the current payment methodology for Part B drugs, ensuring that community-based physician practices can continue to provide complex therapies.
• Implement a Manufacturer Rebate Model
  Substitutes reduced physician add-on payments with equivalent rebates from pharmaceutical manufacturers to the Centers for Medicare & Medicaid Services (CMS), protecting providers while preserving Medicare savings.
• Protect Patient Access
  Ensures that Medicare beneficiaries can continue to receive life-saving treatments, including urologic cancer therapies, in convenient, local settings.
• Maintain Cost Neutrality
  Keeps patient cost-sharing and Medicare reimbursement based on the negotiated drug price, while assigning the additional dispensing payment to manufacturers, resulting in no added costs to patients or the Medicare program.

Impact on LUGPA Members

• Reimbursement Stability
  Protects independent urology practices from unsustainable cuts to Part B drug payments, preserving their ability to offer physician-administered therapies.
• Enhanced Patient Access
  Prevents shifts to hospital settings by allowing patients to receive timely, high-quality care in familiar, accessible community practices.
• Medicare Program Savings
  Supports Medicare’s cost-saving goals without shifting the financial burden to providers or beneficiaries and may encourage greater use of lower-cost negotiated drugs.
• Support for Independent Practice Models
  Recognizes that independent practices lack the 340B pricing advantages or cross-subsidization options available to hospitals, making preservation of ASP+6% reimbursement essential for sustainability.

Why It Matters

Without this legislation, IRA-driven changes could force many independent practices, particularly those in rural or underserved areas, to stop offering critical therapies. This would reduce access and drive up costs, as Medicare pays approximately three times more for drug administration in hospital settings. Patients may face delays, travel burdens, or disruptions to care continuity.

The bill offers a practical, budget-neutral solution that sustains access, supports physician practices, and upholds the integrity of the Medicare program.

LUGPA’s Position

LUGPA strongly supports passage of the Protecting Patient Access to Cancer and Complex Therapies Act to:

• Safeguard Patient Access
  Ensure that patients can continue receiving urologic and other complex therapies in community settings.
• Protect Independent Practices
  Maintain financial viability for practices that would otherwise be harmed by reduced drug reimbursement.
• Balance Savings with Sustainability
  Promote a rebate-based approach that meets Medicare savings goals without compromising access to care.

Next Steps

LUGPA urges Congress to advance this legislation without delay and encourages our members to engage with lawmakers to highlight the bill’s importance to patient care and practice sustainability. We will continue to work with congressional leaders to ensure that independent urology practices are protected from unintended consequences of drug pricing reform.

Advocacy Win – Bipartisan Bill Introduced to Protect Access to Life-Saving Therapies

July 10, 2025 

We are proud to share a major advocacy victory: the bipartisan reintroduction of the Protecting Patient Access to Cancer and Complex Therapies Act, led by Representatives Greg Murphy, M.D. (R-NC), Adam Gray (D-CA), and Neal Dunn, M.D. (R-FL).

This is a landmark moment for LUGPA and a direct result of our sustained advocacy and strategic engagement on Capitol Hill. After more than two years of building bipartisan support, especially among key Democratic leaders, we are thrilled to see this critical legislation introduced with backing from both parties.

A Direct Result of LUGPA’s Advocacy

LUGPA has been a driving force behind this legislation, working to ensure that Medicare reforms do not come at the expense of patients or the long-term viability of independent practices. The bill directly addresses unintended consequences of the Inflation Reduction Act (IRA), which threatens to undermine access to physician-administered therapies through significant reimbursement cuts.

Your support, through advocacy engagement, fly-ins, and personal stories, has played a vital role. And importantly, your advocacy donations have helped demonstrate vital support for our most committed champions.

What the Bill Does:

The Protecting Patient Access to Cancer and Complex Therapies Act ensures physicians can continue offering life-saving treatments—many of which are central to urology—by:

• Preserving ASP+6% reimbursement for Medicare Part B drugs.
• Implementing a manufacturer rebate model that preserves Medicare savings without penalizing physicians.
• Protecting patient access in community-based settings.
• Maintaining cost neutrality for both the Medicare program and patients.

Why It Matters:

Without this legislation, reduced reimbursement under the IRA could make it financially unsustainable for independent practices to administer complex therapies. This would limit access, especially in rural and underserved areas, and drive more care into costly hospital settings.

This bill offers a practical, bipartisan, and budget-neutral solution that protects patients, supports practices, and aligns with Medicare’s goals.

What It Means for LUGPA Members:

• Reimbursement Stability – Helps practices continue delivering essential therapies without financial strain.
• Enhanced Patient Access – Keeps care in trusted, local settings.
• A Strong Advocacy Voice – Reflects years of proactive LUGPA leadership in Washington.

A Shared Win for the LUGPA Community

This bill would not be possible without the collective advocacy of our members. Your ongoing donations to LUGPA’s advocacy help fuel this work, making it possible for us to build bipartisan coalitions, educate lawmakers, and drive policy solutions that benefit your practices and your patients.

We thank Representatives Murphy, Gray, and Dunn for their leadership and remain committed to working with Congress to advance this legislation.

Together, we are protecting patient access and the future of independent urology.