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CMS Part B Payment Model Would Reimburse with Fixed Percentage Plus Flat Fee


IP Blog | Dave Melin | April 3, 2016

BioBlog Weekly oncologyThis week in healthcare: more details about CMS’s proposed new Part B Payment Model, and Medicare officials say they are halting a plan to penalize doctors for which prostate cancer screening tests they order.

CMS Tests Indication-Based Pricing with New Part B Payment Model

In their recently-released proposal to change how physicians are reimbursed under Medicare Part B, “CMS proposed using a fixed percentage of 2.5% and a flat fee of $16.80 per drug per day, which would be updated annually.”

Medical Officials Halt Proposal to Penalize Doctors for Some Prostate Cancer-Screening Tests

After receiving “a wave of negative comments”, officials from Medicare have said they have “temporarily abandoned a proposed measure that would have penalized doctors for ordering ‘non-recommended’ prostate-specific antigen tests to screen for prostate cancer.”

Bernie Sanders’ Bad Medicine for Drug Prices

This Bloomberg articles argues that Democratic Presidential Candidate Bernie Sanders is “worrying millionaires, billionaires and now drug patent holders” with his recent support of a letter urging “breaking a patent-protected monopoly” to lower drug costs.

Penn Studies Show High Out-of-Pocket Costs Limit Access to Lifesaving Specialty Drugs

Two recent studies out of the University of Pennsylvania suggest that “high out-of-pocket costs for specialty drugs appear to pose a very real barrier to treatment.”

Americans Pay 300% More for This Prostate Cancer Drug than Much of the Rest of the World

Xtandi, a prostate cancer drug, is causing a stir as some members of Congress and nonprofits are calling for a hearing regarding its $129,000 annual cost — “more than three times the price in Japan and Sweden and four times the Canadian cost.”

Blue Cross and Blue Shield of Illinois and Illinois Cancer Specialists Announce First Oncology Intensive Medical Home Pilot in the State

Recently Blue Cross and Blue Shield of Illinois announced it would partner with Illinois Cancer Specialists to launch Illinois’ first oncology intensive medical home pilot, whose goal will be “to provide coordinated, cost-effective care, in part, through the use of evidence-based medical treatment guidelines.”

Highmark Cancer Collaborative Launches in Pennsylvania

Recently insurer Highmark along with several partner organizations announced a new Highmark Cancer Collaborative, whose goal is to “create a replicable model for the creation and dissemination of best practices in cancer care.”

Feds Charge Cambridge Drug Firm, Former Execs with Misleading Investors

According to charges recently filed by federal officials, “executives at Cambridge-based Aveo Pharmaceuticals committed fraud by failing to tell investors that the Food and Drug Administration explicitly recommended a second late-stage trial of its kidney cancer drug in 2012, a year before the drug was rejected.”

FDA Gives Medtronic’s PillCam OK for Expanded Indication on Major Risk Patients

Medtronic’s ingestible PillCam has been approved by the FDA for “an expanded indication in patients who are at major risks for colonoscopy or moderate sedation.”

Actinium Receives Orphan Drug Designation from FDA for lomab-B in Treating Refractory and Relapsed Acute Myeloid Leukemia in Elderly Patients

Actinium Pharmaceuticals has announced that “the U.S. Food and Drug Administration (FDA) has granted orphan drug designation for Iomab-B, a radioimmunotherapeutic that conditions relapsed and refractory Acute Myeloid Leukemia (AML) patients for a Hematopoietic Stem Cell Transplant (HSCT), commonly referred to as a Bone Marrow Transplant (BMT).” The company will soon being a Phase 3 clinical trial to further test the drug.

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