Is it time to give up on biosims as the answer to high drug prices? Some experts say yes with suggestions for greater savings. Other measures this week to lower healthcare costs include CMS allowing health insurers to implement copay accumulator programs, which are intended to encourage the use of generic drugs, as well as new primary care payment models. And in oncology news, a combination of targeted molecular therapies appears to produce better results than single therapies. This and more are the top stories in this week’s Innovation Partners BioBlog.
CMS to allow copay accumulators, cut exchange user fees
On Thursday, CMS finalized its rule that would allow health insurers to implement copay accumulator programs to prevent drug manufacturer coupons from applying to a patient’s annual limit on out-of-pocket costs in situations where a generic drug is available. CMS hopes that the rule will encourage patients to use generic drugs to lower spending. The rule would apply to individual market, small group, large group and self-insured group health plans starting in 2020.
Time to give up on biosims, experts say. Price regulations would deliver more savings
Experts are saying it’s time to get rid of the U.S. biosims program, according to a recent report. The market has been slow to generate savings on price reductions from biosims. Instead, the same experts would like to see an independent body that would set price levels after medications lose their exclusivity. It is estimated that the U.S. could save $50 billion a year by using cost plus or other formulas to set prices for biologics. This would be up to 10 times the amount saved with biosims.
Personalizing Precision Medicine with Combination Therapies Improves Outcomes in Cancer
Treating patients with personalized, combination therapies appears to improve outcomes in cancer, according to a new report. Instead of a single molecularly targeted therapy, a combination of therapies may work better. The prospective navigation trial (Investigation of Profile-Related Evidence Determining Individualized Cancer Therapy or I-PREDICT) enrolled patients with previously treated metastatic cancers at either Moores Cancer Center or Avera Cancer Institute in Sioux Falls, South Dakota. Of the patients treated who were highly matched with combination treatments that targeted multiple alterations, 50 percent saw their disease respond compared to 22 percent that were unmatched or less well matched.
CMS announces new primary care payment models aimed at greater shared risk
The Trump Administration is experimenting with several new primary care payment models, including one that would shift providers to global payments. Called the Primary Cares initiative, the aim is to push primary care providers to take on more risk, according to officials. The goal is to elevate the role of primary care in American healthcare and pay providers for outcomes rather than per procedure. A secondary goal is to free doctors’ time from paperwork to focus more on patient care.
Medicare hospital fund reserves likely to be exhausted in 2026: U.S. report
Social Security program costs are likely to exceed total income in 2020 for the first time since 1982 and Medicare’s hospital insurance fund will be depleted in 2026. This agrees with previous predictions related to the Medicare hospital insurance fund. This is according to a report from the board of trustees for Social Security and Medicare, who also projected that Social Security funds could be depleted by 2035, leading to potential reductions in expected payouts to retirees and other beneficiaries.
Some drug companies boost lobbying efforts amid scrutiny from Congress
According to disclosures filed this year, AstraZeneca, Bristol-Myers Squibb, Johnson & Johnson, Eli Lilly and Genentech all increased their lobbying efforts in the first three months of this year. Others are cutting back on lobbying efforts. This in the wake of several Trump Administration efforts to address high drug prices and another effort to tie Medicare payments for drugs to the amount paid by other industrialized nations.
**Top image credit: FILE PHOTO: U.S. Administrator of the Centers for Medicare and Medicaid Services (CMS) Seema Verma (C) is joined by Concerned Women for America CEO Penny Nance (L) at the White House in Washington, U.S., April 13, 2017. REUTERS/Jonathan Ernst/File Photo. Featured in article Medicare hospital fund reserves likely to be exhausted in 2026: U.S. report