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Is CMS About to Revamp Doctor Drug Payments Affecting Reimbursement?


IP Blog | Dave Melin | February 14, 2016

BioBlog Weekly oncologyThis week in healthcare: a memo from CMS suggests they may soon be considering changes to doctor drug payment systems, and NCCN issues new Evidence Blocks for breast, colon, kidney, and rectal cancers.

Medicare Weighing Changes to Doctor Drug Payments, Memo Shows

A recent memo that was temporarily released on CMS’s website (the memo is no longer visible) suggests that CMS is considering an initiative that “tells Medicare contractors who process payments to set up a system allowing the government to vary by geographic location how much it reimburses doctors for the drugs they administer.”

New NCCN Guidelines Include Evidence Blocks to Illustrate Value in Breast, Colon, Kidney, and Rectal Cancers

NCCN has now published updated NCCN Guidelines with Evidence Blocks for breast, colon, kidney, and rectal cancers. The guidelines are geared to “illustrate five key components of value for specific therapeutic regimens: efficacy, safety, quality and quantity of evidence, consistency of evidence, and affordability.”

Sanders Says Single-Payer Healthcare Can Happen in His First Term if ‘People Demand It’

Democratic Presidential candidate Bernie Sanders has strongly supported transitioning to a single-payer system and said that “he hopes it’s something he could accomplish in his first term.”

Wall Street’s Answer to Cancer

Wealth management company UBS is urging some of its clients toward impact investing in cancer: “Those who have dollars they can put away for the long haul can now invest them in potentially life-saving cancer research and hope for a venture-capital-like return down the line.”

‘Close to Criminal’

An oncologist is speaking out about what he says is greed driving prices sky-high for cancer patients: “As an oncologist, I’ve had patients delay or actually stop treatment because of these prices. … Patients have stopped treatment because of side effects before, but now they’re saying “I can’t afford this.” I’d never seen this in the past. … And some of them are stopping and dying as a result.”

ASCO Issues New Guideline on Use of Biomarkers to Guide Early Breast Cancer Therapy Decisions

ASCO has released a guideline detailing their “evidence-based recommendations on the appropriate use of breast tumor biomarker tests to guide decisions on adjuvant systemic therapy.” An ASCO spokesperson said, “These latest recommendations truly inform physicians about which tests need to be performed.”

Novartis Sets Heart-Drug Price with Two Insurers Based on Outcome

Novartis has made deals with Cigna and Aetna, reportedly to secure “a performance-based price for the Swiss drugmaker’s new heart drug, Entresto.”

JOP Study Finds Cost Differentials in Similar Chemotherapy Regimens

A recent study comparing the costs of 62 similarly effective chemotherapy treatments has found that “a significant cost differential exists, the highest being noted in breast cancer regimens (∆$71,041 for metastatic and ∆$63, 926 for curative).”

Sandoz Files for Approval of Neulasta Biosimilar in Europe

Sandoz has now filed in both Europe and the United States for approval of its biosimilar drug similar to Amgen’s Neulasta.

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