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Mary is the associate editorial director for The American Journal of Managed Care® (AJMC®), The Center for Biosimilars®, and Evidence-Based Oncology™. She joined AJMC® in 2013 and oversees speaker recruitment and panel preparations for AJMC®'s premier annual oncology meeting, Patient-Centered Oncology Care®.

She has a BA in communications and philosophy from Loyola University New Orleans. You can connect with Mary on 

Articles

New data from the POLARIX STUDY show that substituting polatuzumab vedotin for 1 part of a classic first-line chemotherapy combination to manage diffuse large B-cell lymphoma improved progression-free survival without compromising health-related quality-of-life.


Additional Results From POLARIX Study Show Improved PFS With No Reduction in HRQOL

Jared is a freelance writer for The American Journal of Managed Care® (AJMC®), and previously worked as a senior editor for HCPLive® at MJH Life Sciences®.

He has an MA from University of Sioux Falls. You can connect with Jared on 

First steps include assembling equity data and reaching out to veterans’ advocacy groups.

Veterans Health Stakeholders Identify Priorities to Ensure Health Equity in Telehealth 

Rose is a freelance writer for The American Journal of Managed Care® (AJMC®), where she previously worked as an editor.

She has a BA in journalism & media studies and Spanish from Rutgers University. You can connect with Rose on 

A new study estimates that prescription of standard-of-care non–small-cell lung cancer (NSCLC) therapies is lower than expected in Medicaid programs, with significant variation between states. 

Targeted Therapies for NSCLC May Be Underused in Medicaid Programs, Study Suggests

Jaime is a freelance writer for The American Journal of Managed Care® (AJMC®), where she previously worked as an assistant editor.

She has a BA in print journalism from Penn State University. You can connect with Jaime on 

With most previous studies on ocular myasthenia gravis stemming from investigations the neurology field, the present investigators came to their conclusion via neuro-ophthalmic analysis.


Ocular MG Should Be Considered in Patients With Ptosis, Diplopia, Says Study 

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1rem

Compendium

 Immuno-Oncology compendium is a comprehensive resource for clinical news and expert insights for treatments that utilize the body's immune system to fight cancer, such as immune checkpoint inhibitors and chimeric antigen receptor T-cell therapies.

 recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

This week, the top managed care stories included, CMS allowing step therapy in Medicare Advantage plans in a bid to allow for drug price negotiation; larger practices with more resources, technology and care management processes have higher readmission rates than smaller practices; studies find that empagliflozin also reduces liver fat in patients with diabetes and nonalcoholic fatty liver disease.

Listen above or through one of these podcast services:

CMS Will Allow Medicare Advantage Plans to Use Step Therapy to Negotiate Drug Prices

CMS Approves Extra Payments for CAR T, Increases Other Payments in Final Rule

Larger Practices Spend More on, Have Higher Readmission Rates for Medicare Beneficiaries

Liquid Biopsy Identifies Patients More Likely to Benefit From Immunotherapy in NSCLC

Studies Point to Empagliflozin as First Choice for Fatty Liver Disease in T2D

Discussing Increased Prevalence of NAFLD and NASH, and the Current Lack of Treatments

Read more about the stories in this podcast:

Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast.

Podcast: This Week in Managed Care&mdash;Step Therapy in Medicare Advantage and Other Health News

Health literacy in the United States is low to begin with, and health financial literacy is even lower. The changing health insurance system is partly to blame. A few decades ago, health insurance covered everything. Now, patients have a lot more financial responsibility, and they don’t always understand it. In cancer, health financial literacy is particularly important since treatment can be so costly.

This episode of Managed Care Cast includes conversations with a few experts in the field: Yousuf Zafar, MD, MHS, of the Duke Cancer Institute; Clara Lambert, BBA, OPN-CG, chair of the Association of Community Cancer Centers Financial Advocacy Network Advisory Committee; Todd Yezefski, MD, senior fellow in the Clinical Research Division at the Fred Hutchinson Cancer Research Center and Division of Medical Oncology at the University of Washington; and Michele McCourt, senior director of the Cancer

A Descriptive Study of Patients Receiving Foundational Financial Assistance Through Local Specialty Pharmacies: www.ajmc.com/journals/supplement/2018/the-patient-assistance-safety-net-how-many-need-help-how-many-are-helped/a-descriptive-study-of-patients-receiving-foundational-financial-assistance-through-local-specialty-pharmacies

Impact of Trained Oncology Financial Navigators on Patient Out-of-Pocket Spending: www.ajmc.com/journals/supplement/2018/the-patient-assistance-safety-net-how-many-need-help-how-many-are-helped/impact-of-trained-oncology-financial-navigators-on-patient-outofpocket-spending

Policy Improvement Areas to Reduce Financial Hardship: www.ajmc.com/conferences/pan-2018/policy-improvement-areas-to-reduce-financial-hardship

Addressing Financial Concerns at the Outset to Improve Patient Outcomes: www.ajmc.com/conferences/pan-2018/addressing-financial-concerns-at-the-outset-to-improve-patient-outcomes

Financial toxicity impacts a lot more than a patient's finances&mdash;it leads to nonadherence and poorer health outcomes. Financial navigators are increasingly being used to be proactive about addressing high healthcare costs and the resulting financial toxicity.

Addressing Financial Toxicity With Navigators and Better Conversations Around Decision Making

This week, the top managed care stories include Senator Bill Cassidy's new plan to lower healthcare costs; policy recommendations from the American Diabetes Association on how to lower insulin prices; and coverage from the American Society of Clinical Oncology annual meeting.

Senator Cassidy Unveils Proposal to Lower Healthcare Costs

ADA Issues Recommendations Designed to Fix Insulin Pricing, Accessibility Crisis

Persephone Trial: Cutting Trastuzumab Duration by Half Safer, Efficacious in HER2-Positive Breast Cancer

Remote Monitoring Can Reduce Radiation-Related Symptoms in Head and Neck Cancer

2018 American Society of Clinical Oncology Annual Meeting

Pembrolizumab Improved OS, PFS as First-Line Treatment in NSCLC

What We're Reading: WellCare—Meridian Deal; Virginia Set to Expand Medicaid; High Court Rebuffs Planned Parenthood

Seema S. Sonnad Emerging Leader in Managed Care Research Award

Podcast: This Week in Managed Care&mdash;Bringing Down Health Insurance Premiums and Other Health News

A study published in Nature Medicine found that certain tumor mutations are more persistent and may predict immunotherapy responses more reliably than overall tumor mutational burden. 

"Persistent" Subset of Tumor Mutations May Predict Immunotherapy Response

A Q-TWiST analysis of ZUMA-7 trial data suggests that axicabtagene ciloleucel (axi-cel) in the second line is beneficial to quality-adjusted survival and is a viable option for patients with relapsed or refractory large B-cell lymphoma after first-line chemoimmunotherapy. 

Axi-cel Shows Improved Quality-Adjusted Survival Versus Standard of Care in LBCL

At the 2022 annual meeting of the American Society of Hematology (ASH), customized cancer immunotherapy treatments now share the limelight with bispecific antibodies, which made news across disease states from large B-cell lymphoma to follicular lymphoma to multiple myeloma; as their name suggests, these treatments aim at 2 targets, increasing their potency against cancer. 

From Lymphomas to Myeloma, Bispecific Antibodies Make a Big Splash at ASH

The findings include the identification of a 12-gene signature that could be used to categorize patients as high or low risk.

Immune Profiling Study Offers Potential New Patient-Stratification Tools in Glioblastoma

 During 2022, the FDA approved 2 chimeric antigen receptor (CAR) T-cell therapies for use in second-line treatment, offering new treatment choices but raising the question: What options remain once a patient relapses after CAR T?

How CAR T Therapies Stack Up Against Standard of Care for LBCL Across Lines of Treatment, Cost Perspectives

New immunotherapies are changing the shape of oncology care, but there is also a need for a system that provides these high-quality therapies to the patients most likely to benefit from them. This might mean doing an assessment and a deeper dive into patient functional status, says Alonso V. Pacheco, MD, medical director and medical oncologist/hematologist, Rocky Mountain Cancer Centers.

As more targeted therapies, personalized treatments, and immunotherapies come to market, how well are they being integrated into everyday practice and making their way to patients?

The truth is that patients are being screened for actionable mutations every day. I'd say most patients have a chance of benefiting from that if they do. I think immunotherapy has changed the face of oncology. We have patients that would have for sure died had they not received immunotherapy, and now they walk into our clinics, unimpaired by their cancer and living a full life, continue to work and provide for their families in their 60s. And it's made a dramatic impact. We all see that.

I think that's what we're trying to do, making sure that we still have a system that can provide high-quality therapies for those patients that are likely to benefit from it, but also give patients a real understanding of what other therapies are and also reach deeper into patients’ functional status and do, at least the beginning, a comprehensive geriatric assessment, which is the [Cancer and Aging Research Group (CARG) Chemotherapy Toxicity Tool calculator]. When you're asking those questions about whether they can walk a block and whether they can take their own medicines at the right time, those have far-reaching implications.

What's behind being able to take your medicine at the right dose at the right time? It kind of is a surrogate for grip strength, whether you can open a pill bottle. I asked the patient about that today. She was like, “Well, my grip is too weak to open a pill bottle. So, now I asked my pharmacist to give me a pill bottle that doesn't have childproof covering on it.” That was a question I wouldn’t have asked 6 months ago, and I think being a leader in this pilot has made a difference.

Videos

There Is a Need to Identify Patients Most Likely to Benefit From Immunotherapies, Says Dr Alonso V. Pacheco 

There is no easy fix to financial toxicity among patients who have cancer, and financial toxicity has not been investigated enough even though fixing it can save costs because patients are going to do better, noted Stephen M. Schleicher, MD, MBA, chief medical officer at Tennessee Oncology.

What are some optimal ways to help patients overcome financial toxicity so they will not delay cancer care?

Financial toxicity is a huge problem, and there's no easy answer. If a patient has new lung cancer and needs a PET scan, needs mutational testing, odds are they're going to need immunotherapy. They might have a target where they don't, but they very well could need immunotherapy. That's going to be expensive, but it's also a very effective treatment that's changing how lung cancer is thought of.

But even if you choose the right drugs, even if you only ordered the test absolutely necessary, which will include next-generation sequencing—and that's not the most expensive piece of the pie, but there's a lot of stuff you need full staging—it's going to be expensive. So, there's no easy solution to just fix financial toxicity. Definitely, you have to always do what's appropriate, because that at least limits any unnecessary financial toxicity.

At Tennessee Oncology we are blessed. We take everybody who walks in our door. I don't have to even think about if a patient's insured or not. If that patient needs an immunotherapy, I can order it and don't need permission from anybody and we will eat the costs if we need. We gave $100 million of free drug last year, but we're big so we can do that. But we really rely on great community partners. Community outreach is a huge focus at Tennessee Oncology, because we need to let these partners know how much we appreciate them.

There's a group in Lebanon called Sherry’s Run that helps with a lot of financial support for patients. There are other groups that help focus purely on utilities, transportation, and food.

A good thing about EOM [the Enhancing Oncology Model] is it does focus on social determinants of health. It doesn't fix it, but it's just an acknowledgement. People recognize, you can have all the best drugs in the world, but if a patient can't get to clinic, can't be healthy, doesn't have family support or a fringe support, it's going to be tough. How do we address those? And that's hard, because there's no businesses yet that know how to do that.

So, we rely on our amazing community partners. And it's our job to be great community partners to them and give back to the community. But I would love people to figure out how to make a model work to address those such important pieces of health care that are often forgotten. And not only is that the right thing to do, but if you can help fix those things, it's also going to save cost for the system, because patients are going to do better.

It's in an insurance plan’s, it's in an estate plan’s, it's in the government's plan, it's in their best interest to figure out how to do that and actually aligns what's best for the patient and what's best for the system and will lower costs and improve quality. But it's hard to fix and people haven't focused on it enough yet.

Stephen M. Schleicher, MD, MBA, chief medical officer at Tennessee Oncology, addresses the “huge problem” of financial toxicity among patients with cancer, which can be attributed in part to both the high price of targeted treatments and even from ordering only necessary testing.
