Cost-Reduction Strategies in MDS Treatment Pathway

Dr Haumschild leads a discussion regarding cost-associated burden for patients with MDS.

Ryan Haumschild, PharmD, MS, MBA: As we move forward in the discussion, it’s important that we talk about the future considerations and the unmet needs with myelodysplastic syndrome. I want to get your opinion. Let’s start with Dr Weaver, because the economic and payer standpoints are important. Myelodysplastic syndrome is costly [in terms of] medical and pharmacy benefit. What should be considered to reduce the patient economic burden and help us manage total cost of care within myelodysplastic syndrome?

Jay Weaver, PharmD, MPH: Thanks for the question. Of the things that are particularly challenging in this disease state, we talked about the Medicare benefit and the way it’s structured. Whether it’s on the commercial side, within the managed Medicare space, or in the fee-for-service Medicaid space, we’re going to need to come up with better ways to align the benefits so we don’t have disconnects in the benefit or differences in the experience of costs among them.

As we heard from clinicians who see these folks in their practices, we’re making treatment decisions in some cases because of practical issues with it, that someone simply can’t afford a medicine that might be more convenient or effective. We’re going to have to think through ways to align those benefits from a benefit-design standpoint to continue to iterate and modernize the Medicare drug benefit through the eyes of the regulatory landscape and advocacy. There are limits to the innovation that you can do as a payer within that space without the thumbs-up from regulators. There’s a lot of good opportunity where maybe the private sector and regulators can come together and come up with solutions that might help bridge some of these challenges. That will give patients and hopefully clinicians a better experience in caring for their patients.

Ryan Haumschild, PharmD, MS, MBA: I like what you said. I sometimes think about this from my perspective as well, because site of care can be expensive. If we can provide an oral therapy and the patient can be compliant, it could reduce costs to the plan. At the end of the day, if a patient is being compliant, we’ve recognized that they can have better quality of life and less progression of disease. That’s so important. If the patient isn’t being compliant, [it’s helpful to] have the option to bring them in and give them the injection to make sure they’re getting that medication. There are many good considerations. This is a tough disease state to manage because of the strong supportive-care requirements around the therapies.

With that, there’s still an unmet need. Compared with other treatments, there are many more lines of therapy that give better overall response rates and durability of responses. In myelodysplastic syndrome, we’ve recently had a lot of approvals. That’s a great thing, but I still feel as if there’s more to come.

Dr Weaver, when we think about the management of myelodysplastic syndrome, there’s something else going on: reform in Medicare Part D. There might be some changes in payments in terms of the patient’s out-of-pocket expense and how much therapies will be paid for. Can you expand upon what that impact might look like? How does that play in the role of the treatment, cost, and coverage of myelodysplastic syndrome therapies?

Jay Weaver, PharmD, MPH: That’s a good callout. One of the things we’re doing with plans is evaluation. The reform is going to help lower some of the liability a patient will have in their benefit. Basically, they won’t have to continue to pay full coinsurance in some levels of their benefit. Clinicians like me are helping to look at who this is going to apply to, and they’re working closely with actuaries who are modeling the cost impact. It’s very encouraging for patients that some of these folks may not experience some of the higher costs they have today in the drug benefit side.

That being said, there will also be an offset of premiums based on that as we increase the cost for the pool of people. The premiums might be a little higher overall, so people with certain conditions like this don’t pay as high a cost share in that equation. The aggregate of that could be that some patients may not afford their plan, but people who have coverage will probably have a better experience. We’re trying to balance those 2 things out.

Transcript edited for clarity.

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