In this week’s Innovation Partners BioBlog, we share the news that Medicaid won expansion in three states; Montana was the holdout among the four states allowing voters to choose expansion. CMS modified its proposed code changes in responses to an outcry from physicians groups concerned that the code changes would unfairly penalize those treating complex cases. This and more in our weekly BioBlog.
CVS expects to close Aetna deal by Thanksgiving, floats ‘simpler’ PBM models
Five states still need to grand approval, but CVS remains hopeful that its Aetna deal will close by Thanksgiving. The $69 billion acquisition of Aetna has not been without its detractors but appears to be very close to final. CVS reported third-quarter revenues at $47.3 billion and gross profit exceeding $7.3 billion.
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Big wins for Medicaid: Voters in Idaho, Utah and Nebraska approve expansion
Four states allowed voters to decide on Medicaid expansion. The states include Idaho, Utah, Nebraska, and Montana. Among the four, three approved expansion, including Idaho, Utah, and Nebraska. Montana failed to approve the vote. Montana had already expanded Medicaid, but the latest vote would have continued funding the program by increasing taxes on tobacco products. It failed with 55% voting against it.
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CMS modifies proposed changes to E/M codes, delays implementation until 2021
The Centers for Medicare & Medicaid Services moved ahead with parts of its plan to consolidate codes for Medicare patient visits. However, the Center did make changes in response to thousands of comments received from doctors nationwide. The agency will consolidate codes for “evaluation and management” (E/M) visits to three. It will maintain the level 5 code that is used for physicians who see the sickest patients who require more services.
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Physician groups hope to work with CMS on E/M implementation, ensure fair reimbursement
Physicians group welcomes a move to put on hold a final rule for the Medicare 2019 physician fee schedule. Streamlining of E/M payments are on hold until 2021. Many groups believe the proposed changes hurt physicians who treat complex cases. The relevant parties will continue working towards a compromise.
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Kumbaya in Washington: Democrats, GOP, and Trump all pledge to work to bring down drug prices
President Trump expressed his support for working across the aisle on drug prices at a press conference that spanned about an hour and a half on Wednesday. He has also threatened not to work with Democrats who scrutinize his administration too closely. Congress appears to be united in their desire to examine the rising costs of drugs and bring down drug prices.
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National Study Aims to Demonstrate Value of Navigation in the Cancer Care Continuum
The Academy of Oncology Nurse & Patient Navigators (AONN+)is working to address this challenge of quantifying the role of patient navigators in oncology care. The group will launch a national, multisite study aimed at answering key navigation questions. The study entitled “National Evidence-Based Oncology Navigation Metrics: Multisite Exploratory Study to Demonstrate Value and Sustainability of Navigation Programs, ”is a collaboration among AONN+, Chartis Oncology Solutions, LLC, and the American Cancer Society that will evaluate the validity and reliability of 10 navigation metrics selected from a list of 35 evidence-based metrics developed by AONN+.
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FDA Accepts Regulatory Submission for LYNPARZA® (olaparib) Maintenance Therapy in Newly-Diagnosed, BRCA-Mutated Advanced Ovarian Cancer and Grants Priority Review
AstraZeneca and Merck (known as MSD outside the United States and Canada) today announced that the U.S. Food and Drug Administration (FDA) has accepted a supplemental New Drug Application (sNDA) for priority review for the approval of LYNPARZA tablets as a maintenance treatment in patients with newly-diagnosed, BRCA-mutated (BRCAm) advanced ovarian cancer who were in complete or partial response following first-line standard platinum-based chemotherapy. A Prescription Drug User Fee Act (PDUFA) date is set for the first quarter of 2019. This is the first U.S. regulatory submission acceptance for a poly ADP-ribose polymerase (PARP) inhibitor in the first-line maintenance setting for advanced ovarian cancer, and, if approved, will be the fourth indication for LYNPARZA in the U.S.
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