OBR Daily Commentary - Leukemia (includes ALL, AML, APL, CLL, CML, MDS, Myeloproliferative Disorders, Myelofibrosis)

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At $475,000, New Cancer Drug Raises Thorny Questions About Drug Pricing — And Value

(STAT/The Pharmalot View) Sept 4, 2017 - A first-of-its-kind cancer treatment is generating unbridled excitement — but also underscoring intense concerns over pricing and value.

Thomas Marsland, MD (Posted: September 05, 2017)

quotesWOW...that is a hunk of change...BUT it would appear that Novartis is at least following some of the suggestions in the recent ASCO paper on drug prices. They would appear to be looking at whether the drug works or not as part of the pricing. In addition they are also considering different pricing for different diseases with different efficacy and hence a somewhat different value proposition. Both approaches suggested in the ASCO report. With that said, $475,000 is still a heck of a lot of money. There is still very much a lack of transparency in how they came up with that number. It is interesting the market was predicting even higher pricing so this number makes them look good. They quote a billion dollars in investment but that is the number quoted for any new drug so why the huge pricing difference for this drug compared to other new innovative cancer therapies. Clearly Novartis has taken some steps toward better drug pricing but no question we still need to do better at controlling new drug costs (some old ones too...) quotes

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Novartis Wants Japan To Link Drug Price To Patient Outcomes

(Nikkei Asian Review) Oct 5, 2017 - Swiss drugmaker Novartis seeks to bring a cutting-edge cancer treatment to Japan under a pricing model linked to patient outcomes, asking for payments from only those who benefit from the therapy.

Thomas Marsland, MD (Posted: October 05, 2017)

quotesThis is an interesting concept. Although this sounds good it may not in the long run hold down drug costs. If a producer knows that 20% (40,50 whatever %) of the treatments are not effective then what is to prevent them from just adding 20% to the initial cost of the drug knowing that they will have to refund that 20%? This indeed is a proposal that should be studied and indeed was discussed in the ASCO white paper on drug costs but is really needed is transparency on how drug prices are developed in the first place. quotes

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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.

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

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Tomasz M. Beer, MD, FACP

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