OBR Daily Commentary

forumImage

U.S. Medicare Sets Outpatient Rate For Yescarta Reimbursement

(Reuters) Apr 5, 2018 - Medicare, the U.S. government healthcare program for the elderly and disabled, will pay hospitals close to its standard mark-up rate for administering cell therapy Yescarta for cancer outpatients, who will have a co-payment of nearly $80,000, according to the Centers for Medicare & Medicaid Services (CMS).

Read Article arrow

Winston Wong, PharmD (Posted: April 09, 2018)

quotesCMS has set the reimbursement for their near normal outpatient rate, thus CMS is treating the CAR-T therapies as an outlier, since the normal hospital reimbursement would be based upon the DRG. Given the co-pay cap, there seems to be little margin for the institution. Need to watch can see what will happen with the additional service reimbursement request.quotes

Add Comment 1 Comment
forumImage

PhRMA Ads Blame Insurers For Drug Costs

(The Hill) Mar 27, 2018 - The pharmaceutical industry's top trade group on Tuesday launched a new series of advertisements as part of its drug pricing campaign aimed at blaming cost increases on insurers and pharmacy benefit managers.

Read Article arrow

Winston Wong, PharmD (Posted: April 05, 2018)

quotesIts still comes down to a simple fact. No matter what the cost of a medication is, someone has to pay. Negotiated discounts and copay coupon programs are simply cost shifters, much like the concept of a patient copay.When a discount is issues, someone else is forced to pick up the difference. Even in light of UHC and Aetna declaring that all rebates will be passed on to the member, there is still a discount present. Why not then just charge a lower price?quotes

Add Comment 1 Comment
forumImage

CMS Starts to Cover Broad Cancer DNA Tests, Boosting Foundation, Thermo

(Xconomy Boston) Mar 19, 2018 - The Centers for Medicare & Medicaid Services, which administers the federal Medicare insurance program, will begin covering FDA-approved diagnostic tests that scan tumors for a range of genetic mutations.

Read Article arrow

Winston Wong, PharmD (Posted: April 05, 2018)

quotesFrom a payer perspective, the CMS approval for coverage means that reimbursement for medicare and medicaid plans are mandated. This does not mean that coverage for the commercial population is mandated. Coverage for commercial members will be based upon the clinical utility study results. If the tests are specific to a drug, and will predict if a drug will be effective or not, then commercial business will follow suit. This is because the clinical utility of the test is sound. Anything beyond this will be suspect, and will undergo much scrutiny. There still need to be clinical justification for coverage. As I have noted in the past, FDA approved indication based upon genomic profiling results will prove to be a challenge for payers, and so far, that has held true.quotes

Add Comment 1 Comment

Meet the Editorial Board

Community Oncology
member photo
Dean Gesme, MD

FACP FACPE FASCO President, Minnesota Oncology...

Breast Cancer
member photo
Debu Tripathy, MD

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

Lung Cancer
member photo
H. Jack West, MD

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

Gastrointestinal Cancers
member photo
Howard S. Hochster, MD

Distinguished Professor of Medicine, Rutgers Robert Woo...

Radiation Oncology
member photo
Howard Sandler, MD, MS, FASTRO

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

Community Oncology
member photo
Jeff Patton, M.D.

CEO Tennessee Oncology...

Precision Medicine Section Editor
member photo
Jennifer Levin Carter, MD, MPH

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

Financial Sector
member photo
Michael G. King Jr.

Managing Director and Senior Biotechnology Analyst...

Gastrointestinal Cancers
member photo
Richard Goldberg, MD

Director WVU Cancer Institute Director of Cancer Signa...

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

Professor and Director, Division of Hematology Oncology...

Health Policy
member photo
Ted Okon

Executive Director Community Oncology Alliance...

Community Oncology
member photo
Thomas Marsland, MD

Vice President Integrated Community Oncology Network ...

Community Oncology
member photo
William Harwin MD

Florida Cancer Specialists President and Managing Part...

Health Policy
member photo
William McGivney, PhD

National Health Policy Expert...

Payer
member photo
Winston Wong, PharmD

President, W-Squared Group...