FAIC Act

This bill, known as the "Facilitating Access to Innovation in Cancer Care Act," aims to amend Title XVIII of the Social Security Act to ensure more equitable payment for and preserve Medicare beneficiary access to certain cancer treatments. It addresses concerns that innovative, high-cost cancer drugs and biologics are currently "packaged" into broader payments for hospital outpatient services, potentially hindering access. By requiring separate payment, the bill seeks to better reflect the actual cost of these advanced therapies. Specifically, beginning in 2026, the legislation mandates separate payment for "specified cancer treatments" furnished in hospital outpatient departments if their estimated mean per day product cost meets or exceeds a defined threshold, starting at $350. These treatments are defined as FDA-approved drugs or biologics for cancer detection or treatment, approved on or after January 1, 2008, that would otherwise be packaged for payment. The separate payment amount will primarily be based on the average sales price , with provisions for wholesale acquisition cost or mean unit cost if ASP data is unavailable, while also requiring budget neutrality adjustments to overall Medicare expenditures.