This week’s Innovation Partners BioBlog offers updates from ESMO including biosimilars and studies on the treatment of men with breast cancer. Fourteen new insurers will offer Medicare Advantage plans in 2019, and Medicaid plan sponsors may provide incentives for preventative screenings. This and more in the Innovation Partners BioBlog, your weekly source of healthcare industry highlights.
Oncologists demand more education on the use of biosimilars: ESMO takes action
Biosimilars offer promising innovations in cancer treatment, including immunotherapy, targeted drugs, and vaccines. However, they are costly. ESMO supports their use in oncology as they represent cheaper alternatives to reference biologics with the potential to make optimal cancer care more sustainable and widely accessible. The organization recently published a paper on the use of biosimilars and is engaging in the dialogue around biosimilars.
In the United States, October is breast cancer awareness month. But did you know that every 1 in 100 cases of breast cancer affects men? New studies indicate that drugs used to combat breast cancer in women are effective when used by men. To learn more about the treatment of breast cancer in men researchers analyzed clinical data collected by the Epidemiological Strategy and Medical Economics Metastatic Breast Cancer (ESME MBC) platform (5) between January 2008 and December 2014. The results indicate that tamoxifen monotherapy should be kept as standard hormonal therapy for men with breast cancer.
Merck KGaA says might strike partnership deal this year
German drugmaker Merck KGaA might agree to partnership deals to jointly develop two of its most promising experimental medicines with a rival as early as this year, but more likely in 2019, its drug research and development chief said on Sunday. The market has been focused on whether Merck will partner with a rival to develop M7824, a bifunctional fusion protein, which combines the immunotherapy mechanism of Merck’s approved cancer drug Bavencio with a second immune trigger known as TGF-beta trap. The final word on whether they will partner or not is still pending.
OIG signs off on Medicaid plan’s preventive screening incentive payments
The Department of Health and Human Services’ (HHS) fraud enforcement office signed off on an agreement that would allow a Medicaid plan sponsor to provide incentive payments to providers that increase their preventive health screenings for children.
Medicaid will pay network providers $1 per enrollee for increasing Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services by 10% between 2018 and 2019. Providers that increase screening services by 20% receive an additional $2 per enrollee, and a 30% increase would garner a $3-per-enrollee boost.
CMS eyes Part D catastrophic coverage reforms that would shift risk to insurers
The Trump Administration is seeking ways in which Part D catastrophic coverage may be changed. The Administration believes that Part D needs to be updated. The catastrophic coverage tier of Part D kicks in when a member reaches $5,000 in out-of-pocket costs. At that point, patients pay a flat fee or 5% of the negotiated retail drug cost, and the federal government picks up 80% of the remaining costs and plan sponsors pay 15%.
Catastrophic coverage under Part D was initially developed to encourage private insurers to participate. That incentive may no longer be needed, and the plan may be changed to reflecting changing market forces.
Medicare Advantage Riding High As New Insurers Flock To Sell To Seniors
If you’ve noticed an increase in advertisements for Medicare Advantage, you’re not imagining things. Although experts predicted the Affordable Care Act would curtail Medicare Advantage plans, enrollment in Medicare Advantage has doubled to more than 20 million enrollees, growing from a quarter of Medicare
beneficiaries to more than a third. Beneficiaries may shop for plans until the closing date of December 7th. Fourteen new insurers have joined the ranks of those offering Medicare Advantage, which should give potential enrollees greater choices.