The AMA House of Delegates Update: “And in the End. . . ”

The AMA House of Delegates Update: “And in the End. . . ”

Edward Paul Balaban, DO, FACP, FASCO

Nov 25, 2014

The American Medical Association House of Delegates (AMA HOD) met once again last week in Dallas, Texas. This was the interim meeting where we welcomed ASCO’s new alternate delegate Dr. Kristina Maletz. As always, a wide variety of reports and resolutions were proposed. ASCO, in addition to coordinating the cancer caucus, was called upon from time to time to play a rather vocal role. 

A review of the more prominent oncology-associated resolutions discussed at this meeting should begin with the resolution that proposed insurance coverage for fertility preservation in patients receiving “cytotoxic or immunomodulatory” agents. In short, the language was changed and the definition of just what the AMA should support in coverage for fertility preservation was broadened. The words “cytotoxic” and “immunomodulatory” therapies were removed. The final recorded version reflected AMA support for payment by all payers of any fertility preservation services when fertility may be affected by any necessary medical treatment.

A late resolution recognizing attempts by drug manufacturers and distributors to increase profits by restricting the distribution of their medications was proposed. The HOD strongly reaffirmed the established AMA policies that are opposed to such attempts. These policies urge the pharmaceutical industry to exercise restraint in the pricing of drugs. AMA policy exists that monitors relationships between pharmaceutical benefit managers in the pharmaceutical industry. The AMA will strongly discourage arrangements that could cause a negative impact on the cost or availability of essential drugs.

The resolution that provoked the most discussion for ASCO was a resolution regarding “parity of payment for administration of medications within the same category of drug.” The resolution was proposed by the American College of Rheumatology; the American College of Allergy, Asthma and Immunology; and the American Gastroenterological Association stating that some of the biologics (high-complex biologics) were selectively being covered by two contractors as complex infusions administered to patients with cancer but similar biologics were not covered when administered to patients with noncancer conditions.

The original “resolve” was then to require parity of payment of medicines in the same category of drug. The resolution did receive a large amount of favorable traction when first proposed. This led to a long discussion and negotiation into the night. ASCO’s concern was that reaching out to CMS to require parity of payment might result in a considerable reduction across the board of any or all biologics. In addition, there was substantial corollary opinion refuting whether those outliers existed. This did lead to a long discussion between all the parties, which had the possibility of becoming fairly contentious but fortunately did not. The summation by the AMA HOD was that this resolution should be referred for additional fact-finding related to this issue before any coordinated congressional strategy is proposed. It is my personal opinion that this solution was the most appropriate.

It is interesting that I first approached this meeting as one that would probably not provide much societal controversy. A resolution that was to be sponsored by ASCO in response to a ramped-up USP [United States Pharmacopeia] 800 drug handling publication was pulled (probably to be revisited in the spring) as USP reviews their document.

However, the resolution concerning “parity of payment” turned out to be the one that kept us up and going. My overall impression was that the concerted effort by everyone representing ASCO was needed and crucial. Particularly with this latter resolution, your ASCO representatives and excellent staff had to reach out in various directions enlisting a number of individuals to try and slow down what seemed to be at first an easily passed resolve—mission accomplished. My second opinion was that I was impressed as to how the sponsors of the resolution came to the table to discuss, listen, and eventually accept compromise. ASCO has been in the same position as our colleagues were at this meeting. I have little doubt that at some point ASCO will be in the same position again, and hope that in the end . . . we will continue to do the same.

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