Pharma Group Blames Lack of Outcomes-Based Drug Contracts on Regulatory Red-Tape
(4/19, Mike Stankiewicz, FierceHealthcare) reports “...The National Pharmaceutical Council said earlier this week in a white paper that many regulatory barriers get in the way of payers and drug-makers making value-based contracts, which could lead to lower costs and increased innovation...NPC suggested some remedies, including allowing drug outcomes—like hospitalizations—that fall outside the scope of an FDA-approved label and exempting contracts from Medicaid's best price caps rebate limit.” Full
Examining Consumer Cost Sharing and a Precision Benefit Design With Dr Mark Fendrick
(4/18, Laura Joszt, The American Journal of Managed Care) reports “Current policies being employed to limit spending can have serious consequences for patients. In the April issue of The American Journal of Managed Care®, A. Mark Fendrick, MD, co-authored a paper that examined the relationship between consumer cost sharing for branded antidepressants and the initiation of branded therapy among patients who were filling a prescription for a generic medication to treat major depressive disorder.” Full
Video: Mark Fendrick, MD, Explains the Motivation Behind Value-Based Insurance Design
(4/19, OBR Oncology) “Dr. Fendrick, Director, Value-Based Insurance Design, University of Michigan, tells us about the motivation behind value-based insurance design.” View Video
COPD Study Finds Benefits, Risks in Comparison of Triple, Dual Therapies
(4/18, Allison Inserro, The American Journal of Managed Care) reports “A new study comparing triple therapy for chronic obstructive pulmonary disease against dual therapy resulted in a lower rate of moderate or severe COPD exacerbations and a lower rate of hospitalizations. However, triple therapy had a much higher incidence of pneumonia, which the researchers said was to be expected.” Full
Three Steps Toward a More Sustainable Path for Targeted Cancer Drugs
(4/18, Justin E. Bekelman, MD and Steven Joffe, MD, MPH, JAMA) comments “...Although organizations that produce practice guidelines have taken steps to incorporate costs, they should go further. ASCO could extend its value framework, which displays cost alongside net health benefit, to prioritize treatment regimens in its clinical practice guidelines. The National Comprehensive Cancer Network could rank-order treatment regimens in its practice guidelines, informed by its Evidence Blocks, which already evaluate affordability alongside other measures. In addition, other groups have developed reports on pricing, effectiveness, and value for cancer treatments and drugs more broadly that merit the attention of guideline writers.” Full
Video: James Hambrick, MD, Explains How Real World Evidence Figures into Clinical Trial Design
(4/18, OBR Oncology) “Dr. Hambrick, Senior Medical Director, Flatiron Health, discusses how real world evidence fits into clinical trial design.” View Video
Which Drug Makers Are Most Vulnerable to a New Cost-Shifting Maneuver?
(4/18, Ed Silverman, STAT Plus) reports “...Clumsily called copay accumulators, these are raising a controversy of their own over concerns consumers will pay more for their medicines. And drug makers, meanwhile, worry about a big financial hit...The maneuver amounts to a new weapon in the ongoing battle between drug companies and pharmacy benefit managers, which are the behind-the-scenes middlemen that create lists — or formularies — of medicines reimbursed by insurance coverage. Drug makers fear the accumulator programs will force them to continue underwriting copay programs in order to maintain prescription sales.” Full
PBMs Offering Prescribers Real Time Visibility On Cost-Sharing, Cheaper Alternatives
(4/18, Cathy Kelly, Pink Sheet) reports “...Pharmacy benefit managers CVS Health Corp. and OptumRx Inc. have launched programs enabling providers to receive information on a patient's cost sharing responsibility for specific drugs and on less expensive alternatives before prescribing or filling a prescription is filled. The programs enhance transparency about drug costs and also reinforce the impact of formulary placement.” Paid Subscription Required
ACOs Don't Always Reap the Expected Financial Reward. Place-Based Care Could Help
(4/18, Matt Kuhrt, Fierce Healthcare) reports “Taking on the responsibility for patients based on a geographic region could help providers better generate financial savings, according to a new opinion piece in the Journal of the American Medical Association...Place-based partnerships involve assigning responsibility for entire populations living within a specific area such as a hospital-referral region or a state. This creates a radical shift in incentives for providers to collaborate with other regional entities, rather than compete, the authors said.” Full
UK: Final NHS Nod for Roche's RoActemra
(4/19, Selina McKee, PharmaTimes) reports “Chugai's RoActemra should be routinely offered throughout the NHS to adults with giant cell arteritis within the next three months, following a final green light from cost regulators...The National Institute for Health and Care Excellence is recommending funding for one year's treatment with the drug for patients who suffer flares of their GCA or may not respond fully to steroids, as their disease is most difficult to control.” Full
Big Data Driving Revolution in Healthcare
(4/19, CIO Review) reports “...With big data at hand, healthcare organizations will enjoy the prompt availability of data at all levels. Vast chunks of aggregated people data structured according to the case histories of consumers, along with their lifestyle and food habits need to be analyzed through big data analytics thoroughly which will help in gleaning insights and using them for future reference. This step is significant in empowering the patients, rather consumers, to take charge of the kind of treatment they are receiving. The aim is thus to increase transparency between the care providers and the consumers.” Full
Report Finds Steady Increase in HSA-HDHP Enrollees
(4/18, Jaime Rosenberg, The American Journal of Managed Care) reports “...Results from the survey found that, when comparing HSA-HDHP enrollment among the 45 insurers that participated in both the 2017 and the 2016 survey, enrollment increased by 9.2%. Since 2005, enrollment in HSA-HDHP plans has consistently increased by 1 to 2 million each year. The majority were enrolled through a large employer; approximately 82% (12.9 million) were enrolled in the large-group market. The remaining individuals were enrolled through either a small employer or through an account they purchased in the individual market.” Full
Viewpoint: Overcoming Challenges to US Payment Reform: Could a Place-Based Approach Help?
Adam D. M. Briggs, BMBCh, DPhil; Hugh Alderwick, BA; Elliott S. Fisher, MD, MPH
April 17, 2018, JAMA
Once-Daily Single-Inhaler Triple versus Dual Therapy in Patients with COPD
David A. Lipson, M.D., et al.
April 18, 2018, The New England Journal of Medicine
A New Framework for Patient Engagement in Cancer Clinical Trials Cooperative Group Studies
Patricia A Deverka, et al.
April 18, 2018, Journal of the National Cancer Institute