OBR Daily Commentary

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COA Statement on Proposed Radiation Oncology Alternative Payment Model

(COA) July 11, 2019 - Based on an initial review of the just announced Centers for Medicare & Medicaid Services’ (CMS) Radiation Oncology Alternative Payment Model, the Community Oncology Alliance (COA) has deep reservations and fundamental opposition to a proposed mandatory or “required” CMS Innovation Center (CMMI) model.

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Thomas Marsland, MD (Posted: July 12, 2019)

quotesCOA absolutely has it right on this proposal. Mandatory participation in these proposed payment models is a non-starter for the medical community. We all support innovative programs to improve quality and cost but mandating unproven programs that potentially have dramatic effects on clinical practice and possibly effecting access to care is not acceptable. These programs should be small pilot to confirm "proof of principle" and voluntary. This is also a potential problem for the possible CAP program again being looked at for medical oncology. COA got it right !!! quotes

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FDA Leverages Private Sector Technology Based Tools In Its Embrace Of Real World Evidence

(Forbes) July 9, 2019 - The FDA is expanding its private sector collaborations to advance its understanding of real world data and evidence. Does this mean that it will begin to approve new drugs and expand labeling on the basis of physician and patient experience, rather than solely on randomized clinical trial data?

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Thomas Marsland, MD (Posted: July 09, 2019)

quotesAs we all know the gold standard will always be the clinical trial, however it is exciting to see the growth of real world data/evidence into the practice of oncology. There are two key factors that will help with the growing use of RWD. First, there are clinical trials that will never be done ie looking into differences in efficacy and toxicity in the same class of drugs will be helpful in determining if a specific drug may have therapeutic benefits in a given class (and if not perhaps cost advantages may drive decision making). Also, in real world practice we see many patients that would never make it into a clinical trial due to age, co-morbid conditions or other factors. Having a base of knowledge on how these patients respond to a given therapy would be priceless in helping to decide what treatment would be beneficial in these clinical situations. Clearly the vendors need to be well vetted in how the data are accumulated and scrubbed to assure that it is accurate and valid. Kudos to FDA for starting to evaluate the role of RWD and its application to clinical practice. quotes

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The Model for Acquiring Oncology Drugs Must Change, Say Kaiser Permanente Experts

(The Center for Biosimilars) July 3, 2019 - Under the approach used by Kaiser Permanente, say the authors, in which oncologists have salaried incomes and are not reimbursed on a relationship to drug price, far higher generic uptake has been observed. There is no question that the cost of oncology drugs is a contributor to untenably high healthcare spending in the United States. While lower-cost generics and biosimilars may appear to be a natural solution to the problem of high prices, these agents have struggled to gain ground in cancer care.

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Thomas Marsland, MD (Posted: July 03, 2019)

quotesHaving lived in both the private practice, buy and bill system, and now as an employed physician in a 340B hospital system, drug profits are always in the discussion regardless of the system. Clearly we choose the most effective, least toxic drug as appropriate for the patient. As to generics, we tend to use them where they are available. Similarly until recently there really has been very limited use of biosimilars. As more become available the use will increase. In our system we are definitely moving in that direction (revenues are part of the driving force in that movement). So drug profits will always be on the table, the question is who makes the profit. Systems are now also making economic decisions on what products to use regardless of how the oncologist gets paid.quotes

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Meet the Editorial Board

Prostate Cancer
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Tomasz M. Beer, MD, FACP

Professor of Medicine, Division of Hematology/Medical O...

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

Associate Clinical Professor, Medical Oncology Executi...

Gastrointestinal Cancers
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Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
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Howard Sandler, MD, MS, FASTRO

Ronald H. Bloom Chair in Cancer Therapeutics
Pr...

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...

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

Director WVU Cancer Institute Director of Cancer Signa...

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

Professor and Director, Division of Hematology Oncology...

Health Policy
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Ted Okon

Executive Director Community Oncology Alliance...

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...