The Medicare Modernization Act of 2003 (“MMA 2003”) was enacted into legislation in 2003 for the purpose of decreasing Medicare expenses because of existing and ever-increasing Medicare budgetary shortfalls. In decreasing Medicare expenses, MMA 2003 specifically targeted oncology pharmaceutical reimbursement by imposing reductions on physician reimbursement by tens of billions of dollars. The initial billion dollar reductions were supposed to take place over a period of five years. However, what actually occurred was these reductions taking place in year one with even more reductions taking place in years two through five. While not all agree, the implementation of these reductions has directly affected accessibility and quality of care in oncology for the Medicare patient primarily in the community oncology arena. Examples of which include, oncologists opting for early retirement, the closing of rural oncology practices, and larger regional practicing closing their outreach clinics. These closings force cancer patients to commute in upwards of 90 miles to over 120 miles away from their homes, often times multiple days a week, for cancer treatment. Further, community oncologists must choose regimens that avoid financial loss, and not necessarily those that are the most effective, or the least toxic for the patient. Many of these physicians simply cannot accept Medicare patients who do not also have secondary insurance because of these reimbursement shortfalls. Where do these patients go? Many go without care, obtain treatment too late because they are shuffled around, and/or are relegated to indigent care clinics. MMA 2003 therefore has succeeded in saving Medicare money, but in so doing has failed to provide adequate care to those to whom they are responsible. So, other than community oncologists, who really cares? Organizations like the AARP are suspiciously silent on the matter, cancer patients themselves are faced with prospect of dying and are therefore not likely to become actively involved in ensuring they receive the care and the treatments they deserve, and physicians are legally barred from aligning together to effectuate legislative change. This issue needs to be brought to the forefront. MMA 2003 needs to be “modernized” again to address these adverse effects, to rectify the inadequacies of care that have resulted, and to take care of our elders suffering and/or dying of cancer. I. Introduction A. MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003 (MMA 2003) 1. Purpose and Intent of the Act – Generally: 2. Purpose and Intent of the Act – As it relates to chemotherapy drugs: 3. Section 303: 4. Section 304 5. What does this mean? II. Community Oncology A. What is community oncology? 1. Who are the community oncology care providers and who are their patients? 2. What effect does MMA 2003 have on community cancer patients? a. Patient accessibility to care i. Physicians opting for early retirement ii. Community practices closing iii. Larger regional facilities closing their outreach clinics iv. Patients in rural areas must commute upwards of 90-120 miles for chemotherapy treatments. b. Quality of care i. Physicians must choose treatment regiments that do not incur financial loss, even if such treatments may be less toxic than others. ii. Many physicians simply cannot accept Medicare only patients. iii. Patients without secondary insurance may be relegated to indigent clinics III. Who Cares? A. Where is the AARP? B. Why don’t patients speak out? C. Why don’t physicians join together and effectuate legislative change? IV. CONCLUSION