Inflation Reduction Act side effect could harm cancer care

When a patient walks into a cancer clinic, the question on his or her mind is not how Medicare calculates reimbursement. It is whether the doctor, nurses and care team will have the time and resources to provide the best possible treatment. That human reality is why a technical problem in the Inflation Reduction Act deserves Congress’ attention now, before it begins to reshape where patients can receive care.

The law’s purpose of lowering prescription drug costs is important and should remain intact. Medicare’s new authority to negotiate prices can bring relief. But lowering a drug’s price should not undermine how it is delivered. In medicine, we would not ignore a serious side effect because the treatment was well intended. Congress should do the same.

Starting in 2028, the law’s formula could cut the clinical reimbursement for administering cancer and specialty medicines, though delivery costs will not fall. Avalere Health, a consulting firm for the industry, estimates practices could lose at least $25 billion across 10 likely negotiated drugs from 2028 through 2032. For clinics on narrow margins, that threatens access.

Cancer treatment is not simply a drug moving from a vial to a patient. Safe care requires nurses, pharmacists, monitoring, navigation, judgment and time. We cannot keep cutting those resources and assume physicians will absorb the difference. Oncologists carry enormous responsibility for patients at frightening moments; the resources we have to meet that responsibility cannot keep shrinking.

Eventually, something gives, and patients lose options. A clinic may scale back certain treatments, close a site, consolidate or sell to a hospital system; a doctor may reduce their workload or leave an unsustainable practice environment.

I see what is at stake on Long Island. I care for a woman with breast cancer who lives in an underserved community and relies on public transportation to reach our closest office. On treatment days, she can spend two to three hours simply getting to her appointment, all while undergoing cancer therapy. She continues to make that journey and fight her disease. But I often wonder what would happen if her local treatment option disappeared and she were forced to travel even farther for care.

Lowering the cost of cancer drugs is important, but those savings cannot come at the expense of the oncology practices that make treatment accessible in the first place. For patients like mine, care close to home is not a convenience; it can determine whether they are able to get treatment at all. We should be lowering the cost of cancer care while preserving access to it — not forcing patients to choose between affordable medicines and a place close enough to receive them.

Besides their location, community clinics often accept broad insurance, let patients stay with doctors and nurses they know, and can cost less than hospital outpatient departments.

Congress need not retreat from drug-price negotiation. H.R. 4299, the Protecting Patient Access to Cancer and Complex Therapies Act, would preserve savings while correcting the delivery system.
Patients’ coinsurance would remain tied to the lower negotiated price, practices would receive stable payment, and manufacturers would rebate Medicare directly.

That solution lets patients pay less, taxpayers keep the savings, and community clinics continue treating patients close to home. I urge Rep. Laura Gillen to co-sponsor this bill.

Doctors are trained to ask whether a treatment works and whether it causes avoidable harm. Congress should apply that discipline to the IRA before patients discover that lower prices mean fewer places to receive care.

This guest essay reflects the views of Dr. Joshua Harris, an oncologist with New York Cancer & Blood Specialists based in Rockville Centre.