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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

In addition, a House committee took testimony this week on the opioid crisis, and the American Medical Association and the American Society of Addiction Medicine unveiled an alternative payment model to cover treatment.

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

According to Jeffery Ward, MD, the study’s lead author, the analysis highlights the struggle to contain healthcare costs. He said: “For years, policy makers and the cancer community have been struggling to contain the rising cost of healthcare in the United States, and bundled payments that include the costs of physician-administered drugs are 1 option under consideration … This new analysis suggests these payment models will create barriers to patients receiving the right drug at the right time.”

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.

Next-Generation Sequencing

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

Gottlieb also addressed drug costs, including the slow rate of biosimilar development. He said, “Market penetration for biosimilars is extremely hard, especially because of the rebate structure for branded drugs. This is a huge impediment for market entry.”

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

Check out the full issue.

For all of us at the Managed Markets News Network, I’m Laura Joszt, Thanks for joining us.

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