2023 Fly in Day: SGO Advocates Call for Chemotherapy Drug Shortage Mitigation and Relief from Medicare Cuts

During the 7th Annual Fly-In Day, held September 20, 2023, SGO volunteers virtually flocked to Capitol Hill to engage with Members of Congress and their staff. Aligned with Gynecologic Cancer Awareness Month and amidst one of the worst chemotherapy drug shortages in decades, this event served as a critical opportunity to inform national leaders about the challenges facing gynecologic cancer patients and their care teams.

This year, 51 advocates, including an unprecedented number of patient advocates, participated in 87 meetings with offices on both sides of the aisle. SGO had two primary requests for lawmakers:  

• Mitigate the current chemotherapy drug shortages and prevent future shortages 
• Avert Medicare physician pay cuts   

Sarah Greene, MPH, Eric Rios-Doria, MD, MS, and Renata Urban, MD, with Rep. Pramila Jayapal’s staff

Chemotherapy Shortages 

The United States is currently experiencing its most severe chemotherapy drug shortage, affecting fifteen essential chemotherapy medications, including critical first-line therapies like carboplatin and cisplatin for gynecologic cancers.  The American Society of Health-System Pharmacists recently found that 99% of hospital pharmacists reported shortages, causing 85% to ration treatments and 84% to rely on different dosages. “No one cares about our patients and our profession more than we do. If not us, then who? If not now, then when?” SGO member Adrianne Mallen, MD, says. 

Addressing these chemotherapy shortages is of utmost importance, and Congress must take immediate action to mitigate the existing crisis and prevent future shortages. The Senate Health, Education, Labor and Pensions (HELP) Committee already passed a Pandemic All-Hazards Preparedness and Response Act (PAHPRA) reauthorization bill, which includes provisions requiring drug manufacturers to notify the Food and Drug Administration (FDA) when shortages are likely due to increased demand and mandating manufacturers to disclose information about the sources of their drug ingredients. Additionally, the Secretary of Health and Human Services (HHS) would provide Congress with a report on the implementation of shortage-related authorities and relevant guidance documents. 

Sarah Greene, patient advocate and first-time Fly-In Day participant, reflects, “The significance of having patient advocates involved in these conversations is monumental. Our faces, voices, and experiences remind policymakers that their legislation carries important implications for people and their families.” Cancer patients, healthcare providers, and pharmacies alike deserve relief from the strain caused by these drug shortages, and Fly-In Day was an opportunity to work with policymakers toward comprehensive solutions. 

Rachel Miller-Garcia, Katie Martino, MPH, Nicole Lugo, MD, and Joshua Cohen, MD, with Sen. Feinstein’s staff

Medicare Physician Pay Cuts 

Gynecologic oncologists and other physicians are facing a looming 3.36% pay cut on January 1, 2024. Urgent Congressional intervention is required to prevent these reductions by year-end. SGO also advocated for more wide sweeping changes to enhance the sustainability of the Medicare physician payment system.  

Describing the direct impact of these pay cuts, Dr. Mallen states, “We cannot keep our practices open if we are not fairly compensated for the work that we do. We also need to be able to keep and retain our essential multidisciplinary team members; this is also part of the overall costs of every practice.” 

These payment cuts coincide with a period of rising inflation. Over the past two decades, physician payments stagnated, while hospitals and physician practices must continue to pay market rate expenses for supplies, equipment, and staff wages. According to an analysis by the American Medical Association (AMA) of Medicare Trustees data, Medicare physician payments have dropped by 26% when adjusted for inflation from 2001 to 2023. The Medicare Physician Fee Schedule lacks a consistent mechanism for updating payments, resulting in Medicare physician service payments falling behind those provided outside of physician offices, the consumer price index, and practice expenses. Immediate action is imperative to address these disparities and ensure fair compensation for medical services. 

Continuing the Conversation 

Events like Fly-In Day underscore the continued need for education and awareness about gynecologic cancers and open conversations about robust policy solutions to ensure that patients receive appropriate and timely care. Sarah Greene aptly notes that advocacy requires energy, something that patients and even physicians may sometimes find in short supply on particularly challenging days; however, patients and medical professionals can channel collective energy towards advocating for equitable outcomes and a future where healthcare policies are more responsive and supportive of both patient and physician needs. 

Adrianne Mallen, MD, and dog Hugo participating in SGO Fly-In Day 2023

“I would both encourage and urge everyone in SGO to consider participating at least once. There is so much positive energy, and you feel recharged after being around like-minded individuals who are all helping on a large-scale,” says Dr. Mallen. 

Though the opportunity has passed to participate in this year’s Fly-In Day event, stay tuned for more information about SGO’s advocacy efforts and how you can support grassroots outreach in the coming months. To view a gallery of photos from this year’s event or past Fly-In Day events, please click here.