OBR Daily Commentary

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OCM Evolving Best Practices: Lessons to Date

(ACCCBuzz Blog) Feb 17, 2017 - Last June, the Centers for Medicare & Medicaid Services (CMS) announced that nearly 200 physician group practices and 17 health insurance companies had been selected to participate in the Oncology Care Model (OCM), the first oncology-specific alternative payment model (APM) pilot.

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Thomas Marsland, MD (Posted: March 02, 2017)

quotesAt this point the OCM is the only oncology specific APM available. The article I think clearly points out some of the issues that this and probably any APM presents. The coordination of care, the extra time and effort in patient follow up, and the documentation of "quality" measures really do present a burden on physicians and practices. In the end I do believe the patients get better care but if these programs are to be successful we need to be sure that the extra services provided are recognized and adequately compensated. As an aside one needs to point out that unless the practice accepts the two sided risk model the OCM really doesn't qualify as an APM. This also potentially puts the practices at an additional economic disadvantage as they take on more costs to provide the added services with no guarantee that they will be compensated.quotes

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Non-Profit Drug Development Could Cut Cost of Cancer Medicines

(ICR [UK]) Feb 9, 2017 - Universities should work with new forms of commercial partner to take their own cancer drugs to market and drive down the ‘spiralling’ cost of new medicines, leading experts propose.

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Thomas Marsland, MD (Posted: February 16, 2017)

quotesThere is no free lunch (unfortunately). I would like to comment on actually two reports in today's OBR that reference Dr Workman's paper on "how much longer will we put up with $100,000 cancer drugs?" Clearly current drug pricing is unsustainable and if allowed to continue will ultimately result in limitation of access in some form. I am not sure that the idea of using academic centers would really lower the costs of development. There is little data to suggest they can do it more cheaply. The authors talk about partnering with private companies in the development process but clearly these companies are going to be looking for a return.... profit. Perhaps the expected returns may be less than traditional pharma but that remains to be seen. So some concepts that also perhaps need to be explored. I agree that the research process needs to be streamlined. With targeted treatments, as the authors suggested, one may not need the huge, expensive trials that have traditionally been done. It would be useful to look at drug costs in the approval process. If a new drug is not significantly more effective or less toxic then perhaps it should show a cost advantage to get approval. We need more transparency in how drugs are priced. Certainly what the "market will bare" is one large determinant now. How much of the cost is determined by marketing (direct to consumer ???, see prior comments) and not actual development. Allowing negotiations for the cost of drugs by the government would also be big step in controlling pricing. So clearly we need to do a better job of pricing cancer drugs. quotes

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Concerns That Rosy Direct-To-Consumer Ads Hype Cancer Drugs To Vulnerable Patients

(WBUR 90.9/CommonHealth [Boston, MA]) Jan 31, 2017 - An oncologist worries that rosy ads for new cancer drugs could raise the hopes of very vulnerable patients unrealistically.

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Thomas Marsland, MD (Posted: February 06, 2017)

quotesI am no fan of direct to consumer advertising. The article very nicely address a number of the reasons. Clearly no physician would not discuss the use of immune therapy in patients for whom it is indicated. On the other hand no one would order any treatment that isn't efficacious just because the patient saw it on TV. My question that has not been addressed is how much does this advertising add to the cost of the drug. Drug costs today are skyrocketing and although not clear to what degree but large marketing budgets certainly don't help cost controls. quotes

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Meet the Editorial Board

Community Oncology
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Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
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Debu Tripathy, MD

Professor and Chair, Department of Breast Medical Oncol...

Lung Cancer
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H. Jack West, MD

Medical Director, Thoracic Oncology Program, Swedish Ca...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Associate Cancer Center Director, Yale Cancer Center P...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Professor and Chair, Department of Radiation Oncology...

Community Oncology
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Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
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Jennifer Levin Carter, MD, MPH

Chief Medical Officer and Founder, N-of-One...

Health Policy
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Joseph Bailes, MD

National Health Policy Expert...

Financial Sector
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Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
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Richard Goldberg, MD

Professor and Physician-in-Chief of the Ohios State Uni...

Editor-In-Chief
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Robert A. Figlin, MD., FACP

Professor and Director, Division of Hematology Oncology...

Community Oncology
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Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
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William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
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William McGivney, PhD

National Health Policy Expert...

Payer
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Winston Wong, PharmD

President, W-Squared Group...