FAIC Act
- Bill Number
- H.R. 8032
- Origin Chamber
- House
- Congress
- 119th Congress, Session 2
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2026-03-20: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- Last Updated
- 2026-05-15T08:07:39Z
AI-Generated Summary
H.R. 8032: Facilitating Access to Innovation in Cancer Care Act (FAIC Act)
Purpose
To amend Medicare's hospital outpatient prospective payment system (OPPS)—a method for reimbursing hospitals for outpatient services—to provide separate payments for certain high-cost cancer treatments. This aims to ensure fair reimbursement for hospitals and maintain access for Medicare beneficiaries to innovative cancer drugs and biologics.
Key Provisions
- Separate Payment Requirement (effective 2026): Medicare cannot bundle (or "package") payment for a specified cancer treatment into the overall OPPS payment for outpatient services if its estimated mean per-day product cost meets or exceeds an annual threshold ($350 in 2026, adjusted yearly by the OPPS fee schedule increase factor).
- Payment Calculation:
- Primarily based on the average sales price (ASP) under Medicare rules, with adjustments matching those for other outpatient drugs.
- If ASP data unavailable, uses wholesale acquisition cost (WAC) or, if needed, mean unit cost from hospital claims data.
- Budget Neutrality: The Centers for Medicare & Medicaid Services (CMS) must adjust other OPPS payments to ensure total spending remains unchanged.
- Definition of Specified Cancer Treatment: A drug or biologic that:
- Was FDA-approved on or after January 1, 2008, for cancer detection or treatment.
- Does not qualify for temporary "pass-through" extra payments.
- Would otherwise be bundled into an OPPS payment.
Significant Changes to Existing Law
- Amends Section 1833(t)(16) of the Social Security Act by adding a new subparagraph (H).
- Shifts from bundled payments (where drug costs are included in a single outpatient service rate) to separate payments for qualifying high-cost cancer therapies, overriding prior packaging rules for these items.
Potential Impacts
- Medicare Beneficiaries: Improved access to new cancer treatments, as hospitals may be less likely to limit services due to inadequate bundled reimbursements.
- Hospitals: Higher, more predictable revenue for expensive cancer drugs administered outpatient, potentially supporting more treatment options.
- Government Agencies (CMS): Increased administrative work to track costs, calculate payments, and maintain budget neutrality; no net increase in Medicare spending.
- No direct effects on international relations.
Main Stakeholders Affected
- Medicare beneficiaries with cancer (primary beneficiaries of preserved access).
- Hospitals and outpatient clinics providing cancer care (gain separate reimbursements).
- Pharmaceutical and biotech companies producing qualifying cancer drugs (potential boost to market uptake).
- CMS (implements and oversees changes).
Notable Legal, Constitutional, or Political Implications
- Legal: Reinforces Medicare's authority to adjust payment methodologies while mandating budget neutrality to comply with fiscal constraints; no challenges to constitutional authority anticipated.
- Political: Bipartisan sponsorship (Reps. Dunn (R-FL) and Soto (D-FL)); focuses on cancer care equity, likely appealing across party lines without expanding overall spending.
- Promotes innovation by protecting reimbursement for post-2008 FDA-approved therapies, potentially influencing future drug pricing and access debates.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (4)
Rep. Soto, Darren [D-FL-9], Rep. Gottheimer, Josh [D-NJ-5], Rep. Kiggans, Jennifer A. [R-VA-2], Rep. Tenney, Claudia [R-NY-24]
Recent Actions
- 2026-03-20: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-03-20: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
- 2026-03-20: Introduced in House
- 2026-03-20: Introduced in House
Bill Versions
- Facilitating Access to Innovation in Cancer Care Act — issued 2026-03-20 — PDF (5 pages)