NCCN Academy for Excellence & Leadership in Oncology
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School of Pharmaceutical & Biotech Business
3.20.19 Orlando, FL
Learn about models for successful collaboration in practice management and Health Information Technology
Payment, efficacy and outcomes are center stage in this week’s Innovation Partners BioBlog. First, we look at costs: the cost of specialty drugs, value-based reimbursement and more. Next, we look at efficacy: Google’s patent application for an EHR-based machine learning program that will help physicians improve treatment, for example. Lastly, we look at outcomes, specifically a new approach to treating a common form of kidney cancer. It’s all in this week’s BioBlog from Innovation Partners.
Costly specialty drugs drive higher spending on provider-administered treatments, study finds
Magellan Rx Management, a pharmacy benefit management company and part of Magellan Health, released its ninth annual trend report. Magellan included information about drugs administered by providers and found that per-member, per-month spending on these therapies increased by 18% from 2016 to 2017, reaching an average of $29.97 monthly, for people enrolled in commercial plans. Emerging therapies with higher price tags account for part of this increase.
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CMS looks to expand Medicare coverage to CAR-T therapy
CMS plans to allow Medicare to pay for chimeric antigen receptor (CAR) T-cell therapy, in which oncologists use a patient’s own immune system to attack a tumor.
The determination would require that Medicare cover CAR T-cell treatments across the country when it is offered in a registry or clinical study approved by the agency. CMS intends to use the coverage to assess how well these therapies work for Medicare beneficiaries. Hospitals and clinicians using the treatments, for example, must join a registry to track outcome data for comparison with clinical trials.
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Google patent indicates plans to develop EHR to predict patients’ clinical outcomes
Google continues its quest to find new applications for machine learning. The company applied for a patent that would utilize electronic health records to assess and predict clinical outcomes. The patent describes a process by which Google would collect, analyze, and use machine learning to predict further health events. The system would include a provider-facing interface. Only aggregated data would be stored. The system uses deep learning with EHRs to suggest clinical predictions and save physicians time.
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CMS’ Demetrios Kouzoukas: Transparency a ‘priority’ at agency as it takes aim at drug prices
Demetrios Kouzoukas, principal deputy administrator at the Center for Medicare & Medicaid Services and director of the Center for Medicare, said that the agency is working across the healthcare system to ensure physicians and patients are more informed about Part D formularies and the drug options they have available. Transparency is now the watchword of the agency, with CMS rethinking its approach to many items including step therapy.
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CVS scraps plan to cut payments to 340B providers
CVS Caremark halted plans to cut payments to 340B providers. In January, the company announced it would delay plans until April, but a company spokesperson confirmed the plans have been scrapped altogether. Many companies, including those who represent 340B providers, had reached out privately to CVS and the resulting decision came from these conversations.
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Study: Payers slowly migrating toward value-based reimbursement
Although CMS appears open to value-based reimbursements, the nation’s health insurance companies still haven’t completely adopted this reimbursement approach. About half (46.4%) of the 150 executives of health insurance companies surveyed said that between 50% and 75% of their current contracts are in value-based models, with about the same number reporting similar adoption within the next two years. More than half of those surveyed said that provider and member engagement remain barriers to success.
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Drug combination may become new standard treatment for advanced kidney cancer
A new treatment protocol may be become the standard approach to metastatic kidney cancer. Immunotherapy drug plus targeted agent provided better progression-free survival and shrank tumors in more patients than standard one-drug treatment. The side effects were similar in both groups. Immunotherapy drug avelumab plus axitinib, a VEGF targeted agent, had a significant advantage in progression-free survival compared with those who received sunitinib (Sutent), a VEGF targeted drug. Sunitinib was the standard treatment for advanced clear cell renal cell carcinoma, a common form of kidney cancer.
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