CER Daily Newsfeed

Medicare Advantage Less Likely to Use Low-Value Cancer Treatments, Study Finds

(6/13, Rosanna Sutherby, Pharm.D., Managed Healthcare Executive) reports “...[Jeah Jung, PhD, MPH] and his team concluded that Medicare Advantage plans have a lower rate of low-value cancer treatment use compared with traditional Medicare. However, they advocate efforts to find ways to reduce low-value cancer treatments in both traditional Medicare and Medicare Advantage plans. The authors wrote, ‘…34.2% of [Medicare Advantage] enrollees and 35.9% of [traditional Medicare] beneficiaries received at least 1 low-value cancer treatment. This suggests that opportunities remain to reduce use of wasteful cancer treatments in both [Medicare Advantage and [traditional Medicare].’” Full

Video: Phase 3 IRAKLIA Trial Compares On-Body vs IV Isatuximab in RRMM: Xavier Leleu, MD, PhD

(6/14, Brooke McCormick, Xavier Leleu, MD, PhD, The American Journal of Managed Care) “The phase 3 IRAKLIA trial assesses subcutaneous isatuximab via on-body injector vs intravenous (IV) administration, in combination with pomalidomide and dexamethasone, in relapsed/refractory multiple myeloma (RRMM).” View Video

FDA Publishes Latest Data on RWE Use in Drug and Biologic Submissions

(6/16, Joanne Walker, The Evidence Base) comments “...One notable observation is CBER's use of RWE, which expanded in FY 2024, with 15 new protocol submissions, a number nearly four-times that in FY 2023. Of these, 12 are safety-focused and three assess effectiveness. Ten protocols support PMRs, compared with just 2 the previous year. The report also highlights the increasing use of EHR data in protocol submissions (8 submissions), while use of registries (7) and claims (5) also increased. All protocol submissions are based on non-interventional study designs.” Full

CMS’ Pay-For-Performance Paradox

(6/16, Aaron R. Wells, William Walters, Richard Hughes IV, Health Affairs Forefront) comments “...We aim to illuminate the current state of disparity regarding monetizing value in delegated-risk contracts between healthcare providers and payers. We use the Next Generation Accountable Care Organization (NGACO) pilot as a case study, demonstrating the significant differences in outcome based upon which methodology is used to define value in monetary terms. In a given year in the NGACO pilot model, one methodology could have yielded savings, while the other yielded losses. The NGACO findings shed light on current models including Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) and the Medicare Shared Savings Program.” Full

Industry Voices—Can Payers Collaborate with Providers to Control Care Costs?

(6/16, Theresa Hush, Fierce Healthcare) comments “...Payers could negotiate the use of bundling certain facility or various provider costs together or work with an outside party to construct methods of masking negotiated rates. There are multiple possibilities for providing essential data while obscuring proprietary or sensitive information. It requires only willingness and creativity to have that conversation and move forward to realize true value-based care.” Full

UK: Myasthenia Gravis Drug Rejected for NHS Use

(6/16, Chloe Aslett, BBC News) reports “...Andy Stephenson, from Doncaster, has myasthenia gravis and has been admitted to hospital 32 times because muscles involved in his breathing stopped working. But since taking the drug efgartigimod, the 45-year-old has not needed to go on a ventilator once and said he had seen a ‘huge improvement’ in his symptoms. The National Institute for Health and Care Excellence (NICE) recommended the drug not be used by the NHS due to its ‘substantial’ cost of more than £6,500 per infusion vial, despite it improving people's symptoms.” Full