New CPT Codes Account for Changing Technology, Cigna Launches New Benefit Solution, More

In this week’s Innovation Partners BioBlog, we feature several stories on the continuing healthcare debate. The President promises a new healthcare plan, but any plan promises to be contentious to some on either side of the aisle. New CPT codes were announced for 2020 that include e-visits and remote monitoring. Cigna launched a new befit solution to make gene therapy more affordable, and a judge rules that the CVS Health/Aetna merger can go forward. These and other top stories in this week’s Innovation Partners BioBlog.

Amgen’s KRAS drug continues to deliver but faces ‘curse’ of high expectations

New data released by Amgen on its KRAS drug indicates that at the highest dosage, it stopped tumor growth for 100% of patients. Earlier data indicated that it stopped tumor growth or shrank tumors by 90% in patients with lung cancer. The first data for the drug, AMG 510, included 10 patients with non-small cell lung cancer (NSCLC) who had been on treatment long enough to be evaluated. Seven of the 13 (54%) saw their tumors shrink, while the remaining six (46%) had their tumors stop growing, showing the drug could control the disease in 100% of patients.
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Lilly’s RET drug, nabbed in Loxo buyout, hits 68% ORR in lung cancer

Lilly’s buyout of Loxo Oncology may already be yielding results. Loxo Oncology has presented new data at the World Conference on Lung Cancer for its RET inhibitor LOXO-292. The drug, known as selpercatinib, demonstrated a 68% objective response rate (ORR) in heavily pretreated RET fusion-positive non-small cell lung cancer (NSCLC) in the phase 1/2 LIBRETTO-001 trial. This is compared to data presented at several U.S. cancer congress last year when the drug (then still owned by Loxo) hit a similar overall response rate.
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Trump Promises ‘Phenomenal’ Health Plan. What Might That Mean?

Although President Trump continues to promise a ‘phenomenal’ health plan, there’s a catch: should the administration continue to push for looser insurance restrictions, expanding tax-free health savings, and containing the cost of prescription drugs – or unveil an entirely new plan? The answer isn’t clear on what course of action the president plans to take. Either action or inaction comes with risks. A new health plan may be greeted with skepticism by both Democratic and Republican loyalists for different reasons.
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Cigna launches new benefits solution aimed at making gene therapy more affordable

Cigna is taking steps to manage the high cost of gene therapy by launching a new benefits solution. The company announced that the new e Embarc Benefit Protection platform combines expertise on medical management, health services and specialty pharmacy from Express Scripts, eviCore, Accredo and CuraScript SD.Health plans that adopt Embarc will pay a per-member, per-month fee to participate in a gene therapy network. Physicians will be required to submit prior authorization for the drugs; once approved, however, there is no patient co-pay. Pharmacies and drug companies will be paid by Embarc for the therapies. Two drugs are currently listed in the program: Luxturna, a gene therapy treatment for people with inherited retinal disease, and Zolgensma, a treatment for children under two years old with spinal muscular atrophy and the world’s most expensive drug.
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CPT changes in 2020 include new codes to allow doctors to bill for digital health

The American Medical Association (AMA) released updated procedure codes for 2020. New codes have been added to reflect the latest technology. Current Procedural Terminology (CPT) codes describe medical, surgical, and diagnostic services provided to patients. They are used to bill outpatient procedures. New codes include those for doctors to bill for e-visits and remote patient monitoring.
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Federal court sides with CVS Health/Aetna on their merger

District Court Judge Richard Leon ruled in favor of CVS Health and Aetna on the settlement agreement allowing them to merge. Opponents did indeed raise substantial concerns, but CVS and the federal government argued persuasively why the merged should continue. CVS Health and Aetna inked their deal in November 2018 for $69 billion but have been awaiting Judge Leon’s ruling to proceed.
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Congress comes back to work as providers make push for changes to surprise billing legislation

Lawmakers continue to disagree on how to handle surprise medical bills. The provider industry spent the summer lobbying hard for an arbitration model to resolve out-of-network payment disagreements instead of fixing a benchmark rate. Two packages have been passed by separate committees, but neither package received the full vote of the House or Senate. The American Medical Association, the American College of Emergency Physicians and the American College of Surgeons support an arbitration model.
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UnitedHealth study: Administering specialty drugs outside hospitals could save $4B

A study conducted by UnitedHealth found that administering specialty drugs in patients’ homes or their doctors’ offices could save $4 billion for insurance plans. UnitedHealth said that changing the location of administering specialty drugs could save $16,000 to $37,000 in savings per patient. Hospital prices are higher whether drugs are administered in a hospital-owned facility or physician practice. The monthly cost per patient for administering such drugs in a hospital was $20,965 compared to $11,619 in a physician’s office to $10,849 in the patient’s home.
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