OBR Daily Commentary

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Health Plans Must Not Discriminate Against Patients with Cancer, ASCO States in Letter to CMS

(ASCO in Action) Jan 4, 2018 - On December 27, ASCO sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma to reiterate the society’s Principles for Patient-centered Health Care Reform and to weigh in on the proposed notice, “Patient Protection and Affordable Care Act; Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2019.”

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Winston Wong, PharmD (Posted: January 10, 2018)

quotesPrior to the "Benefit Exchange" individual market, most states had regulations stating minimal, but essential, mandatory benefit coverage for individual and small groups. Due to the high risk pools in this population, cost ratios were high. Payers had to attempt to manage benefits to minimize losses. Some were aggressive and survived. so if we look back, the model was in place insuring access to care. What came about with the exchange market was that the mandatory benefits were expanded benefit, resulting in a high actuarial cost. Hence, the market blew up. Maybe we need to step back in time to evaluate bringing back a model that may have come closer to being affordable.quotes

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Merck CEO Says More Of Drug Rebates Should End Up With Consumers

(CNBC) Jan 8, 2018 - The CEO of drug giant Merck said Monday that not enough of the rebates being negotiated for medications are being passed on to consumers.

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Winston Wong, PharmD (Posted: January 10, 2018)

quotesAnnual drug price increases is around 7-9% annually. Negotiated Rebates help to counter these increases, but as Mr Fraizer points out, only a small portion benefits the patients directly. What little actually benefits the patient is negated by increases in copays and coinsurances. So maybe the solution is to do away with rebates entirely and move to a straight list price strategy. Then in order to achieve a coverage status, the competition is then convert to a price war. Price wars to lower cost is cleaner and more transparent than todays world of increasing prices, balanced by PBM negotiations to gain bigger rebates, only to have a good portion to go towards their profit margins, and little benefiting the patient.quotes

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Gene Test To Predict Breast Cancer Recurrence Less Cost Effective In Real World Practice

(GUMC) Jan 8, 2018 - The most commonly used gene expression profile test used to help predict breast cancer recurrence may not be as cost-effective as once thought, say a team of researchers led by Georgetown Lombardi Comprehensive Cancer Center.

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Winston Wong, PharmD (Posted: January 10, 2018)

quotesVery interesting results. Accurately stated, early analysis of OncoTypeDx showed positive cost effectiveness based upon ideal conditions. There is no argument that real world practices paint a more realistic analysis of cost effectiveness. While early studies did note that a portion of the women determined to have high risk of recurrence opted to skip chemotherapy treatment. They also note, as within this study, that a portion of women determined to have a a low risk of recurrence went on to have chemotherapy. What one needs to question is why did these women opt to undergo chemotherapy treatment. In addition, if chemotherapy was part of the treatment plan, why was the test even completed? Also, if chemotherapy was not a treatment option, why was the test completed. I do not disagree with the findings, as they confirm the findings of early studies (if you dig into the detail). So maybe the true action point here is what can be done to refine the inclusion criteria to run the test in the first place. Maybe tests like OncoTypeDc and Prosigna will become much more cost effective if completed in the appropriate population. 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

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...