Government rule currently prevent allowing drugs prices to fluctuate based on the stage in which the drug is being used, but changing sentiment may allow for more creativity in how drugs are priced, according to Scott Gottlieb, MD.
Kavita Patel, MD, MS, thinks granting Medicare the ability to negotiate drug prices is unlikely, but indicate-based pricing, or something in that direction, could happen. However, John L. Fox, MD, MHA, noted that the challenge with indication-based pricing is explaining what it is and then administering it.
“So I can see a 10% co-insurance if you have stage 4 metastatic cancer first line, but, I'm sorry, you’ve got metastatic recurrence disease and now you are second line and it's going to go up to 20%,” he said.
Dr Gottlieb moved the conversation to formulary design and what changes are expected to be seen. Ted Okon, explained that the Community Oncology Alliance has seen narrowing networks and plans going into more of a formulary basis.
“The problem in in oncology that's tougher to do,” he said. “But I think what’s going to sort of change some of the rubric here is the advent of biosimilar. You’re getting more biologic completion here and CMS is really adamant about—whether that is going to destroy a nascent industry or not—but they are really adamant about putting all of those under the same codes and allowing prices to be driven down and using it that way.”
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Navigating Health Policy in an Election Year: Insights From Dr Dennis Scanlon
April 2nd 2024On this episode of Managed Care Cast, we're talking with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care®, about prior authorization, price transparency, the impact of health policy on the upcoming election, and more.
Listen
Industry Experts Tackle Specialty Drug Access Challenges for Employer Benefit Plans
May 2nd 2024Representatives from ICON plc and Symphony Health joined forces at AXS24 to discuss the challenges of managing high-cost specialty drugs and how they influence self-funded employer benefit plan design and employee access to specialty medications.
Read More