FAIC Act

Separate Medicare payments for cancer drugs

If enacted, this bill would require Medicare to pay separately for certain cancer drugs given in hospital outpatient departments starting in 2026. For 2026 the per-day product cost threshold would be $350, and later years would rise by the OPD fee schedule increase factor. Separate payment would equal the drug's Average Sales Price (ASP) if available, otherwise the Wholesale Acquisition Cost (WAC), and if neither is available the mean unit cost from hospital claims. The rule would apply to drugs or biologics approved by the FDA on or after Jan 1, 2008 that do not get transitional pass-through payments and that otherwise would be packaged. CMS would adjust other payments so total Medicare spending stays the same. This change could affect what Medicare patients pay in coinsurance for these treatments.