Leveraging Data, Paying for Cancer Care, Drug Price Negotiation Update
Valuate Health Consultancy
Combining real world experience with advanced analytics and insights to improve market access for all.
Effectively Leveraging Pharma and Market Access Data
What’s the most significant mistake pharma and market access make when they work with data? Listen to the latest episode of The IDI podcast to find out!
Thanks to guests?Derek Tancredi, MBA, CSM,?and?Terrill Paterson?for coming on the podcast.
Limiting Financial Toxicity for Cancer Patients: Thoughts on an Ambitious Proposal
Dr. Ezekiel Emanuel, an oncologist, author, and co-director of the Health Care Transformation Institute, recently proposed eliminating out-of-pocket costs for cancer patients in the United States. Valuate Principal John Hennessy?has some thoughts on Emanuel’s proposal.
“Emanuel’s idea is that, once diagnosed, patients would be deemed to have reached their out-of-pocket maximum,” John notes. “He identifies the lack of a moral hazard in seeking cancer care that is often used to justify high deductibles and coinsurance for those seeking routine care. Furthermore, Emanuel argues that the demand for cancer care is relatively inelastic and is primarily determined by the physicians treating the cancer.
“Some progressive employers have adopted policies similar to Emanuel’s proposal in exchange for patients electing to participate in Centers of Excellence programs. In many cases, these employers include support for non-traditional out-of-pocket costs, like transportation and lodging.
“It’s worth looking beyond the eye-catching headline of his op-ed. Emanuel advocates for full coverage of evidence-based and cost-effective treatments. He cites the management of bone metastases and radiation therapy for prostate cancer as areas where more cost-effective care would be covered at full cost. However, other therapeutic options may have out-of-pocket costs for patients.
“This trade-off is not necessarily unreasonable, but it’s certainly something we’re not used to in America. We are watching the early growing pains of the Inflation Reduction Act, which, in broad strokes, trades off limiting out-of-pocket costs for Medicare members in exchange for price negotiation on drug therapies that have the highest cost impact to Medicare. It’s clear that not everyone is entirely on board with this trade-off, and we might find the same challenges in Emanuel’s proposal. I would imagine provider systems that have invested in proton therapy might not be as excited about his ideas as others.
“Finding the right path to limiting financial toxicity for cancer patients — not to mention all patients with chronic diseases — is a righteous goal but will require compromises from various stakeholders.” — John Hennessy
“I’m sure Emanuel is familiar with the prisoner’s dilemma. This relatively simple game theory problem suggests we are all better off when we cooperate, but individually we might be better off not cooperating.?“We will have to figure out how to get nearly all stakeholders on the same page before we make real meaningful changes in the challenges of financial toxicity for cancer patients.”
What are your thoughts on the proposal? Contact John at [email protected].
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Drug Price Negotiation Update: CMS Issues Revised Guidance
CMS just released revised guidance for its drug price negotiation process:?https://lnkd.in/eGQk6zEH?
The changes:
The revised guidance appears to address the objections raised in several lawsuits recently filed against the program.
Value-Based Care: CMS Publishes List of Enhancing Oncology Model Participants
The?Center for Medicare and Medicaid Innovation?published the list of 67 organizations participating in its Enhancing Oncology Model – which you can find here: https://innovation.cms.gov/innovation-models/enhancing-oncology-model
Although it’s a smaller number of practices than those who participated in the?Oncology?Care Model, John Hennessy?is excited by the breadth of participation across the country in both community and academic settings, as well as rural and urban settings.
“While some practices will be experienced in?value-based care, others may be learning as they go,” John notes. “Programs like?American Society of Clinical Oncology (ASCO)‘s Patient-Centered Cancer Care Certification — a collaboration with the?Community Oncology Alliance — may help practices prepare for and succeed in value-based arrangements such as EOM. It’s an opportunity for all stakeholders in the cancer care?ecosystem to help these practices be successful in this model. Congratulations and best wishes to these innovators.”
America Has Fewer Primary Care Physicians Than Europe — What’s the Impact?
“America has a smaller share of primary care physicians than most of its European counterparts,” per Kaiser Family Foundation Health News:?https://lnkd.in/eqcQtnTT
Young patients increasingly prefer the convenience of local clinics or online appointments to a trusted?primary care physician.
The changing patient-provider relationship impacts market access?for?pharma. Without the PCP as the point of contact, it becomes more challenging for manufacturers to create and execute an effective commercialization strategy.
One tool that can help is Access Next, a platform that allows reps to pull up accurate, up-to-date coverage data from payers, pharmacies, and employers — commercial insurance, Medicare, or Medicaid — and includes details for every account, region, and county.
Learn more about Access Next: https://www.entreehealth.com/products/access-next/