Value-based drug pricing, looser restrictions on Part D drug formularies…it seems as if every group and organization is trying to help patients access and pay for their medications. In this week’s Innovation Partners BioBlog, we’ll take a look at oncology biosimilars, Medicaid value-based drug pricing, and much more.
Do Oncology Biosimilars Have a Place in Clinical Pathways?
Journal of Clinical Pathways spoke with Gary Lyman, MD, MPH, professor of medicine, University of Washington, and co-director, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, regarding the process of bringing oncology biosimilars to market and their potential uptake in clinical practice as well as pathways. Dr. Lyman shares his thoughts on biosimilars and their place in clinical practice.
Medicaid To Introduce Value-Based Drug Pricing
Medicaid expansion coupled with rising drug costs have forced state Medicaid authorities to seek new payment mechanisms that would contain drug costs. In June, the Center for Medicaid Services agreed to let Oklahoma test value-based pricing for schizophrenia drug Aristada (aripiprazole lauroxil). The drug price decreases every other month if the prescription is refilled. The longer patients take the drug, the greater the rebate. These and other ideas are under discussion in this thought-provoking piece from Forbes.
Insurers Fret Over How To Pay For Gene Therapy As The Science Advances
Gene therapy is advancing and offering hope to patients, but the cost is quite steep. Insurers balk at the cost, which is often in the hundreds of thousands of dollars. According to one analyst, gene therapy developers and payers are starting to embrace the idea of alternative payment models. A look at possible ways in which more people can benefit from – and pay for – gene therapy.
New JOP Study Implements Scalable System to Improve Clinical Trial Appointment Scheduling
Scheduling systems may not sound important, but many studies point to their importance in patient care. Now, a new Quality in Action study in the Journal of Oncology Practice (JOP) outlines a successful effort to improve appointment scheduling for patients participating in clinical trials. The methodology of this project can be utilized to evaluate and optimize other processes and units within cancer centers outside of scheduling.
House leaders ask PBMs to explain their impact on downstream drug costs
The leading pharmacy benefits managers from around the country are coming under heat again as drug prices remain in the spotlight. They are being asked to explain how they negotiate lower drug prices for consumers. House leaders are asking pointed questions, including, “…the relationship of a drug’s list price with the price negotiated and the different incentives that are offered to encourage reductions in list price.” More on their line of questioning and the role PBMs play in drug pricing in this article.
Anthem, Walmart Announced MA Partnership
Anthem and Walmart have forged a partnership to allow Medicare Advantage patients more access to over the counter medicines and health services at Walmarts nationwide. Walmart is now ubiquitous in most parts of the nation and often the central store in a rural area, serving the entire local community. The move is hailed by KPMG as “a natural” fit that may signal a return to using partnerships to introduce new products, rather than full-fledged M&A.
CMS loosens restrictions on Part D drug formularies to allow indication-based coverage
The Trump Administration is loosening how Part D formularies are created. The new, flexible approach offers sponsors the opportunity to exclude or add drugs based on a particular indication. Plan sponsors believe this provides them with a viable negotiating tool to lower the cost of drugs. The announcement was made on Wednesday and the change will be effective January 1, 2020.