From chimeric antigen receptor T-cell therapy to value-based contracting, reimbursement issues dominated reader interest.
Breakthroughs in cancer therapy are demanding new ways to pay for care. While terms like value-based contracting have been around for several years, there’s more interest than ever as gene-based therapies hit the market. Here are the top stories for 2018 from our journal at the intersection of cancer care and reimbursement, Evidence-Based Oncology™ (EBO):
5. Value-Based Contracting: Creating the Terms of Engagement Around High-Cost Cancer Therapies
Susan Dentzer, the chief executive officer of the Network for Excellence in Health Innovation, shared this commentary about the alternative approaches emerging for pricing new therapies, including cancer treatments, that hold manufacturers accountable for value instead of tying prices to the volume sold. Dentzer’s article appeared in the April issue, which published just as CMS was quietly back-pedaling on its highly touted agreement with Novartis to fund the first chimeric antigen receptor (CAR) T-cell therapy.
4. CareMore's Togetherness Program Addresses a Symptom of Living With Chronic Illness: Loneliness
Robin Caruso, MS, LCSW, the first chief togetherness officer for CareMore Health, discussed the innovative program within the context of its helpfulness for seniors who are dealing with the aftermath of cancer treatment. CareMore is receiving national attention for its approach to treatment loneliness as a chronic condition, due to its effects on other clinical outcomes and costs. Since Caruso’s article appeared, CareMore has released data showing that the program is having a positive effect on the company’s expenditures on emergency department care.
3. A Retrospective on the Oncology Care Model
Authors from Flatiron Health, which this year made headlines when Roche bought out the company for $1.9 billion, offered their perspective on how well CMS’ alternative payment model in cancer care is performing and what tweaks might make it work better for everyone. Flatiron makes the case that technology providers deserve a stronger voice at the table than they have had to this point.
2. Recent Approval of Trastuzumab Biosimilar, Ogivri, Has Implications for Patients and Industry
When will biosimilars make their mark? This look at the potential for Ogivri, the biosimilar for the oncology mainstay trastuzumab, shows just how much it’s needed and what barriers remain. Nearly a year after this story appeared, the biosimilar still has not reached the US market.
1. With Approval of CAR T-Cell Therapy Comes the Next Challenge: Payer Coverage
Reimbursement woes remain a huge threat to the future of CAR T-cell therapy. While Medicaid officials in New Jersey and Pennsylvania told EBO in this article appearing in the February issue that they planned to reimburse for the live-saving treatment, their current plans are unclear in the wake of the collapse of CMS’ initial agreement with Novartis. A year later, Medicare still has not reached a permanent fix to the reimbursement impasse. About the only bright sign is a novel “carve out” solution reached by the Massachusetts Medicaid office and presented at the Academy of Managed Care Pharmacy NEXUS meeting in late October.