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U.S. Government Releases Reference Pricing Guidance and Financial Toxicity of Cancer Therapies


IP Blog | Dave Melin | October 19, 2014

BioBlogWeeklyThis week in health care, CMS announces a new ACO program and the debate over increasingly unmanageable drug costs continues, U.S. budget deficit falls to a six year low and ASCO highlights cancer disparities.

Feds release guidance on reference pricing, network adequacy in ACA group plans

The U.S. Departments of Labor, Treasury, and Health and Human Services have collaborated to produce a Frequently Asked Questions (FAQ) document that addresses questions about reference pricing in “non-grandfathered group health plan[s]”.

Financial Toxicity is a Side Effect

Following the recent discussion of high drug costs on 60 Minutes, some organizations including Fight Colorectal Cancer are jumping on the bandwagon to condemn financial toxicity as a “very real side effect of treatment”. They also argue that “the high cost of cancer drugs must be publicly discussed with all stakeholders, including companies, payers, and patients, and that resolution of the problem is critical for the sake of patients.”

CMS Announces ACO Investment Model

Last week, the Centers for Medicare & Medicaid Services announced a new initiative for ACOs (Accountable Care Organizations) that will “better coordinate care to rural and underserved areas by providing up to $114 million in upfront investments to up to 75 ACOs across the country.” CMS also said that this initiative was targeted for ACOs that joined the Shared Savings program between 2012-2014, as well as those hoping to join for 2016.

Got Insurance? You Still May Pay A Steep Price For Prescriptions.

A report from Kaiser Health News illuminates the struggle between the helpfulness of specialty drugs — which can provide new alternative treatments and help patients whose conditions are unaffected by previous treatment — and the high, sometimes unaffordable costs they can sometimes levy on patients even after insurance.

Poll: Many insured struggled with medical bills

A new poll from the Associated Press found that many people with insurance still struggled to pay their medical bills. Many respondents cited high deductibles as an issue, and many others said they were still confused about what exactly was covered and how to use their coverage.

Research From ASCO’s Quality Care Symposium Highlights Impact Of Social Factors On Cancer Treatment Disparities and Approaches For Improving Care

In a precursor to their Quality Care Symposium, ASCO released four new studies about “the role social factors play in cancer treatment disparities, as well as effective approaches to improving the quality of care.” Study topics included advanced cancer patients who have dependent children, hormone therapy adherence in Medicare’s subsidy program, oncologist participation in tumor board meetings, and patient death after cancer surgery.

Budget deficit falls to $483B, a six-year low

On Wednesday the Treasury Department announced that the U.S. federal deficit for fiscal year 2014 was $483 billion, the lowest it has been since 2008 (when it was $455 billion). Treasury Secretary Jack Lew noted that this was a “dramatically-reduced deficit. Coming down to below 3 percent of GDP is a meaningful step.”

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