Costs for Seniors Jump as Generic Drugs Move to Higher Formulary Tiers in Part D Plans
May 22, 2018 – Allison Inserro
May 22, 2018 – Allison Inserro
May 22, 2018 – Jaime Rosenberg
What We're Reading: Cancer Clues and Patient Records; Va. Meets on Medicaid; Healthcare for Undocumented
May 22, 2018 – AJMC Staff
May 22, 2018 – Samantha DiGrande
May 21, 2018 – Allison Inserro
May 21, 2018 – Jaime Rosenberg
May 21, 2018 – AJMC Staff
May 21, 2018 – Alison Rodriguez
May 20, 2018 – Mary Caffrey
This Week in Managed Care: April 20, 2018
This week, the top managed care stories included a new bill in Congress to tackle the opioid epidemic; an analysis that warns against including drug costs in bundled payment models; the FDA commissioner shares ideas to improve innovation and access to next-generation sequencing.
Congress offers a solution to the opioid crisis, a study warns against putting drug costs in bundled payments, and the FDA Commissioner shares ideas to improve innovation and access to next-generation sequencing.
Welcome to This Week in Managed Care, I’m Laura Joszt.
Congress Tackles Opioid Problem
This week, Senators Lamar Alexander and Patty Murray introduced a bill with 40 different proposals to address the opioid crisis, following months of hearings before the Senate Health Committee.
Among other measures, the bill will:
- Reauthorize grants for prevention and treatment for 3 more years
- Spur development of non-addictive painkillers
- Improve border seizure of illegal drugs like fentanyl
- Support states with prescription drug monitoring programs
- Strengthen community mental health care
Bundled Payments and Drug Costs
Folding drug costs into bundled payments could destabilize cancer care delivery, according to a new analysis. The hypothetical model appeared in the Journal of Oncology Practice, an official journal of the American Society of Clinical Oncology.
Researchers used Medicare reimbursement rates from the first quarter of 2016 to create the model, based on 2 cancer types:
- Advanced stage III colon cancer
- Metastatic non–small cell lung cancer
The analysis found that including drug costs would lead to reimbursement that reflected patient mix, not the physicians’ care management.
For more, read the article.
FDA Commissioner Scott Gottlieb, MD, made 3 proposals to speed availability of next-generation sequencing, which he said will reduce administrative burdens and bring this innovation to the patients more quickly.
Gottlieb unveiled the plans at the 2018 Community Oncology Conference, held by the Community Oncology Alliance in National Harbor, Maryland.
The proposals involve:
- The design, development, and analytical validation of NGS-based diagnostics
- Guidance on the use of public human genetic variant databases
- Processes to speed the FDA submission process for diagnostic developers
For more coverage of the COA meeting, visit the conference page.
Improved Outcomes in Lung Cancer
Lung cancer patients are about half as likely to die if they take pembrolizumab with chemotherapy when newly diagnosed, according to new clinical results.
The study presented this week at the American Association for Cancer Research was called “practice changing” by researchers, who said it could mean most lung cancer patients will receive immunotherapy right away instead of trying chemotherapy first.
Pembrolizumab, sold as Keytruda by Merck, was found to work on a large, genetically diverse group of patients. Said Leena Gandhi, MD, PhD: “Often the most effective drugs are effective when you really pinpoint a patient population. [This trial] was remarkable in that everybody seemed to be helped to some degree.”
Evidence-Based Oncology™ Issue Available
The changing idea of risk is the theme of the current issue of Evidence-Based Oncology™.
Alternative payment models, including the Oncology Care Model (OCM), call on physicians to assume risk in caring for patients. But risk means different things in different settings, and that’s been one of the barriers to change.
The current issue features:
- A discussion of value-based contracting
- A case study of implementing the OCM in a community oncology practice
- A discussion of a pilot involving nurse navigators with Horizon Blue Cross Blue Shield of New Jersey
For all of us at the Managed Markets News Network, I’m Laura Joszt, Thanks for joining us.