US Oncology Issues Statement Regarding Impact of Legislation Relating To Reimbursement for Prescription Drugs Under Medicare
01 Diciembre 2003 - 5:37PM
PR Newswire (US)
US Oncology Issues Statement Regarding Impact of Legislation
Relating To Reimbursement for Prescription Drugs Under Medicare
HOUSTON, Dec. 1 /PRNewswire-FirstCall/ -- US Oncology, Inc. today
released the following statement: Last week, the United States
Congress passed a bill providing for a prescription drug benefit
under the Medicare program. Outpatient oncology drugs were already
covered by Medicare, but this new prescription drug benefit bill
includes a significant reduction in reimbursement for oncology
drugs administered in the community setting. Currently, physicians
treating cancer patients receive under Medicare 95 percent of
average wholesale price (AWP) for pharmaceuticals they administer
to patients in the community setting. Under the bill, Medicare
reimbursement for most drugs used to treat cancer patients would be
reduced to 85 percent of AWP in 2004, with the Secretary of Health
and Human Services having the discretion to reduce reimbursement to
80 percent of AWP under certain circumstances relating to specific
drugs. Starting in 2005, reimbursement would be based upon "average
sales price" (ASP), and set at 106 percent of ASP. Drug makers
would report the ASP to the government, but the Secretary of Health
and Human Services would have authority to adjust payments for any
drugs if the ASP does not reflect "widely available market prices."
To partially offset the reductions in reimbursement for
pharmaceuticals, the bill also increases the amount paid to
oncologists for practice expenses other than drugs. The exact
nature of the increase is not detailed in the bill, but based on
the Congressional Budget Office's analysis published on Nov. 20,
2003, the bill will cause Medicare spending for drug administration
by outpatient medical oncologists and hematologists to increase
from 2003 amounts by approximately $.3 billion in 2004, $.4 billion
in 2005 and $.3 billion in 2006. Significant discretion is given to
the Secretary of Health and Human Services in implementing this
increase. Many details of the legislation, such as the precise
nature of the increase in practice expense reimbursement, remain
undefined. Also, the bill gives the Secretary of Health and Human
Services discretion to implement many of its provisions, including
setting ASP or an alternative basis for reimbursement and
implementing a third-party vendor option for pharmaceutical sales.
During 2004, we believe that the reductions in reimbursement for
drugs will be largely offset by the increase in reimbursement for
other practice expenses, with the main impact of the legislation on
oncology reimbursement occurring in 2005 and beyond. The
legislation represents the most significant cut in government
support for cancer patients in the history of the Medicare program,
and does not achieve the balanced reform for which we have worked
so hard. US Oncology will remain firmly engaged in Washington,
working to ensure that cancer patients in the United States
continue to have access to the care they need. While we believe
that the legislation will negatively impact patient access to care,
we remain dedicated to reducing this impact as much as feasible. We
will also continue to inform policymakers in Washington and work
with them to curtail threats to access that we see resulting from
the reduced reimbursement. We believe that oncology practices, both
inside and outside our network, will continue to value the
effective management services we offer to them. We are optimistic
that in this new reimbursement environment oncology practices will
also embrace our strategies: (a) helping practices lower their
pharmaceutical and administration costs, (b) providing the capital
and expertise to expand and diversify into radiation oncology and
diagnostic radiology, (c) providing sophisticated management
services to enhance profitability, and (d) providing access to and
managing clinical research trials. We will continue to assist our
practices in negotiations with private payors, in implementing
programs to enhance efficiencies with respect to drugs and in
expanding service offerings such as PET and IMRT. In addition, we
are optimistic that the passage of the prescription drug bill will
reduce uncertainty regarding prospective Medicare reimbursement for
oncology, allowing us to pursue and implement our strategies in a
more focused and effective manner. Impact on Existing Medicare
Business The new reimbursement methodology under the Medicare
prescription drug bill will adversely impact financial results of
oncologists, including those in the US Oncology network, with
respect to Medicare patients, which will, in turn, under our
service agreements with affiliated practices adversely impact US
Oncology's financial results. Medicare is our affiliated PPM
practices' largest payor, representing approximately 38% of their
net patient revenue. We believe that this impact will largely occur
in 2005 and beyond. In 2004, we believe the increases in practice
expense reimbursement will largely offset the decreases in
pharmaceutical reimbursement under the Medicare prescription drug
legislation. Application of the expected Medicare 2005
reimbursement rates to our historical results of operations for the
first nine months of 2003 would reduce, on a pro forma basis, our
net revenue for the nine months ended Sept. 30, 2003 by
approximately 2% and our net income and earnings per share by
approximately 30%. To arrive at those results, we mathematically
applied those 2005 rates to our net revenue for the first nine
months of 2003 and made no other adjustment to our historical
results. The pro forma financial information is for illustrative
purposes only, and we do not believe the information is indicative
of future results. Given the effect of the Medicare drug
legislation, we are not at this time giving guidance for projected
results of operations for 2004 or beyond. Other matters that could
impact our future results include: (a) any growth in our business,
including from new cancer centers, PET installations or otherwise
expanding operations of affiliated physician groups, (b) the extent
to which non-governmental payors change their reimbursement rates,
(c) changes in practice performance or behavior, including the
extent to which physicians continue to administer drugs to Medicare
patients, or changes in our contracts with physicians, (d) reduced
expenses or changes in our cost structure, including any change in
the prices we pay for drugs, (e) any other changes in reimbursement
or practice activity that are unrelated to the prescription drug
legislation or (f) any repurchases of our common stock made after
Sept. 30, 2003. This pro forma financial information outlined above
should be read in conjunction with the cautionary statements
contained in this release and the "Risk Factors" included in US
Oncology's Annual Report on Form 10-K for 2002 and subsequent
filings with the Securities and Exchange Commission. For all the
reasons outlined in this release, readers are cautioned not to
place undue emphasis on the pro forma information. Conference Call
US Oncology will host a conference call for investors on Tuesday,
Dec. 2, at 10 a.m., CST. Investors are invited to access the call
at 1-877-615-1716 and reference password "US Oncology." The
conference call also can be accessed via Web cast. Details of the
Web cast are available at http://www.usoncology.com/ . A replay of
the conference call will be available through Dec. 9, 2003 at
1-800-642-1687. The access code for the replay is 4266269. About US
Oncology, Inc. US Oncology, headquartered in Houston, Texas, is
America's premier cancer- care services company. The company
provides comprehensive services to a network of affiliated
practices -- comprising more than 875 affiliated physicians in over
450 sites, including 78 integrated cancer centers -- in 30 states,
with the mission of expanding access to and improving the quality
of cancer care in local communities. These practices care for
approximately 15 percent of the country's new cancer cases each
year. This news release contains forward-looking statements,
including statements that include the words "believes," "expects,"
"anticipates," "estimates," "intends," "plans," "projects," or
similar expressions and statements regarding our prospects. All
statements concerning business outlook, reimbursement outlook,
expected financial results, business development activities and all
other statements other than statements of historical fact included
in this news release are forward-looking statements. Although the
company believes that the expectations reflected in such statements
are reasonable, it can give no assurance that such expectations
will prove to have been correct. Matters relating to the
prescription drug legislation that could impact future results and
financial condition or otherwise affect expectations include the
way in which the bill is implemented, including the precise nature
of the increase in practice expense reimbursement and the third
party vendor programs included in the bill, the extent to which
non-governmental payors change reimbursement, changes in
pharmaceutical pricing as a result of the legislation, other
changes to the cancer delivery system precipitated by the
legislation, limitations in the ability of practices to continue
offering chemotherapy services to Medicare patients or maintaining
existing practice sites, how physicians will respond to the
legislation, including with respect to retirement or choice of
practice setting, how our development activities will be impacted
by legislation, and the possibility of additional impairments of
assets, including management services agreements. Other matters
that could further impact future results and financial condition
include reimbursement rates, including in particular, reimbursement
for pharmaceutical products, our ability to maintain good
relationships with existing practices, expansion into new markets
and development of existing markets, our ability to complete cancer
centers and PET facilities currently in development, our ability to
recover the costs of our investments in cancer centers, our ability
to complete negotiations and enter into agreements with practices
currently negotiating with us, reimbursement for health-care
services, continued efforts by payors to lower their costs,
government regulation and enforcement, continued relationships with
pharmaceutical companies and other vendors, changes in cancer
therapy or the manner in which care is delivered, drug utilization,
increases in the cost of providing cancer treatment services and
the operations of the company's affiliated physician practices.
Please refer to the company's filings with the Securities and
Exchange Commission, including its Annual Report on Form 10-K for
2002 and subsequent SEC filings, for a more extensive discussion of
factors that could cause actual results to differ materially from
the company's expectations. DATASOURCE: US Oncology, Inc. CONTACT:
Bruce Broussard, Investor Relations, +1-832-601-6103, or , or Steve
Sievert, Public Relations, +1-832-601-6193, or , both of US
Oncology, Inc. Web site: http://www.usoncology.com/
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