After 10-Fold Cancer Drug Price Increase, ASH Experts Debate Potential Solutions
This week at the American Society of Hematology, a prominent oncology expert from M.D. Anderson Cancer Center weighs in on drug prices in the US.
At the annual American Society of Hematology (ASH) meeting last week, the organization convened a panel of experts to address “an aspect of cancer care that’s increasingly finding its way into the mainstream healthcare discussion at clinical meetings”: rising healthcare costs. What roles do the biopharmaceutical industry and other stakeholders play in the causes of and solutions for rising oncology drug pricing? Three experts argued three different opinions, ranging from “coming down hard on the pharmaceutical industry” to focusing on therapy rather than cost.
An analysis by Avalere health has found that many Exchange insurance plans have set the out-of-pocket spending limit below the maximum amount allowed. This is comparable with other plans, but an analyst also notes that “the tradeoff for lower out-of-pocket spending maximums may be a higher deductible.”
This AJMC article explores “why health plans are reluctant to cover most telemedicine services as part of current payment arrangements” and argues that newer, non-FFS payment models — such as ACOs — may be a more natural fit with telemedicine.
Price transparency: Where is it headed? [subscription required]
In this special report, FierceHealthFinance explores successful initiatives and future goals surrounding price transparency. Although one official noted that “most folks don’t know that price disparity exists,” the report found a “crazy quilt” of “piecemeal” transparency efforts around the country.
This study, published in AJMC, examines the reasons why patients choose to fill prescriptions at an out-of-plan pharmacy (OOPP). Of the survey participants, 86% said they had filled a prescription at an OOPP. Of those, “factors that influenced the decision to use an OOPP included the prescription being less expensive (58%), the OOPP had a discount generic prescription program (57%), and the OOPP’s location was convenient (44%). Thirty-nine percent of respondents reported that using an OOPP helped them afford their prescriptions.”
New changes to the Medicare Shared Savings Program (MSSP) proposed by CMS would “give ACOs an additional three years before they face penalties for poor performance and offer a new model to entice providers to form ACOs.” But health economist Paul Keckley says the proposal doesn’t go far enough: “the changes don’t address some of the things that the ACOs are currently participating would like to have seen.”
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