What should insurers consider when they revise their formularies? Is fee-for-service the answer to the future of healthcare? We look into these top stories and more in this week’s Innovation Partners BioBlog. Other stories this week include the expansion of the Muriad-AstraZeneca/Merck partnership, Western Connecticut Health Network and Health Quests’ partnership, and more.
Departing FDA Commissioner Scott Gottlieb heads to AEI
Scott Gottlieb, M.D., will be heading back to the American Enterprise Institute when he leaves his post as FDA Commissioner. Gottlieb’s affiliation with the think tank goes back to 2003 when he was a resident fellow there. His work as FDA Commissioner earned praise from both Republicans and Democrats, a rarity in the polarized world of politics. Dr. Gottlieb plans to focus on drug pricing in his new role at AEI.
Myriad, AstraZeneca and Merck Expand Companion Diagnostic Partnership
Myriad Genetics, Inc. recently announced it is expanding its collaboration with AstraZeneca and Merck. The collaboration focuses on companion diagnostic services and includes BRACAnalysis CDx® to identify germline BRCA mutations in men who have metastatic castrate-resistant prostate (mCRPC) cancer and are enrolled in the Phase III PROfound (NCT02987543) study. If the study is successful, Myriad intends to file a supplementary premarket approval application with U.S. Food and Drug Administration (FDA) for BRACAnalysis CDx to be used as a companion diagnostic to Lynparza® (olaparib) for its use in this patient population. The collaboration has resulted in multiple approvals so far and appears promising for several areas of inquiry and research.
PCMA report says HHS rebate rule would significantly boost drug, Part D spending
A new reported supported by the Pharmaceutical Care Management Association pans the Trump Administration’s plan to end pharmacy benefit manager drug rebates. The report issued by PCMA states that there is limited evidence to support the plan, and a very low chance that if the plan does go through, it will lower taxpayer’s spending. Instead, they suggest it will increase insurance premiums. A look at their findings and what it might mean for the Administration’s plans.
Medicare Part D wasn’t built for costly specialty drugs. MedPAC wants to change that
MedPAC suggested an overhaul of the Medicare Part D program to address the introduction of costly specialty drugs. The program, MedPAC argues, hasn’t been updated since these expensive medications were introduced into the market, and is ill-designed to address the costs. The suggested changes include restructuring the Part D catastrophic phase and replacing existing discounts in the coverage gap with a manufacturer cap discount that better accounts for emerging therapies.
Western Connecticut Health Network, Health Quest combine to form $2.4B system
Danbury-based Western Connecticut Health Network and New York-based Health Quest announced Wednesday they have merged to create a $2.4 billion system called Nuvance Health. The name, Nuvance, was derived from a combination of “new” and “advance.” The rebooted system will care for patients across New York’s Hudson Valley and western Connecticut.
MedPAC debates what form a Medicare without fee-for-service payment might take
MedPAC announced its intention to focus on value-based payments at a meeting in April. The commissioners discussed what this may look like and its impact on Medicare. The debate followed what’s working and what’s not, especially among accountable care organizations (ACOs) and Medicare Advantage (MA). The article outlines four potential scenarios and what each might hold for the future of fee-for-service.
Five drugs in development Optum says payers, employers should be watching
Optum recently released its list of five drugs to watch in the pipeline, and suggested that payers should keep an eye on drug pipelines as they create and revise their formularies. Drugs such as the ones in this list have been significant cost drivers and tend to address rare and unusual diseases. The complete list of drugs and the diseases they treat is included in the article.