In this week’s Innovation Partners’ BioBlog, states consider several models for value-based drug pricing but face significant challenges to move forward with any of them. A House panel is investigating the role that private equity firms may play in surprise patient billing; many of these firms own physician staffing companies, who are out of a patient’s insurance network even though the hospital may be in-network. Biogen unveils a new search engine to help customer service reps answer doctors’ questions and more in this week’s BioBlog.
School of Pharmaceutical & Biotech Business
10.29.19 Scottsdale, AZ
This program will give pharmaceutical and biotechnology professionals the rare opportunity to view the oncology space, its future and its current operational issues from the provider, advocacy, and payer perspectives.
NCCN Academy for Excellence & Leadership in Oncology – School of Pharmaceutical & Biotech Business will take place on Tuesday, October 29 at The Phoenician in Scottsdale, Arizona.
A new report confirms that states face several barriers when implementing value-based drug pricing models. States including Michigan and Oklahoma are testing outcomes-based approaches. Officials are still learning how best to engage in negotiations with drug manufacturers. All feel as if they are charting new ground in the quest for value-based drug pricing models.
Comments on a new proposal from the Centers for Medicaid and Medicare Services indicate that oncology centers believe a Trump proposal to bundle Medicare payments for radiation therapy will discourage providers from using the new technology. The proposed payment model would pay a physician or radiation therapy center for selected services over a 90-day period. The payment covers only select services such as dose planning, CT simulations, and treatment aids. The goal is to push back against perverse treatment programs that reward physicians and centers for prescribing multiple treatments to get paid more when patients may need less.
Biogen initiated a custom internal search engine that customer service reps can use to find answers about the company’s portfolio of drugs. The AI-powered search engine, created with Lexalytics, replaces FAQs and text-heavy documents that are cumbersome for reps to use. The new system uses natural language processing so that people can type the exact question from physicians to find the answers in the system.
Roche has been looking to capture share from Merck with its Tecentriq-chemo combo treatment for non-small cell lung cancer. Roche announced the results of a phase 3 study this week in which Tecentriq beat chemo at lengthening the lives of previously untreated patients without ALK or EGFR mutations. The study pointed to a survival benefit among those with high levels of biomarker PD-L1. The company said it plans to continue the study to see if Tecentriq benefits patients with lower levels of the protein.
The Department of Health and Human Services’ Office of Inspector General (HHS OIG) found that rebates for Medicare Part D grew by $2 billion from 2011 to 2015. This growth, however, was limited to a minority of Part D drugs and wasn’t enough to offset major spikes in drug prices. OIG analyzed 1,510 brand-name Part D drugs that got rebates every year from 2011 through 2015. During that five-year period, rebates for the specific drugs reviewed increased from $9 billion to $17 billion. Total rebates almost doubled but that wasn’t true for all individual drugs. Increased rebates were allocated to a small minority of drugs.
The House Energy and Commerce Committee launched an investigation into the possible roles that private equity firms play in “surprise” medical billing. Reps. Frank Pallone Jr. (D-N.J.) and Greg Walden (Ore.) sent letters to equity firms that own physician staffing companies this week. Hospitals sometimes contract out the staffing of their emergency room or other departments to these physician staffing companies. These companies, however, may not be part of the patient’s insurance network even if the hospital is in-network. Patients then receive these so-called “surprise” bills when they thought services should be covered because they went to an in-network facility for treatment.