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COA Strongly Supports “Strengthening Innovation in Medicare and Medicaid Act”

(COA) Feb 3, 2020 - CMMI models are important to reform, but impact on patients should be carefully tested prior to widescale implementation.

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William McGivney, PhD (Posted: February 04, 2020)

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The work of COA has been critically important in the support of patients, practicing oncologists, and the enhancement of innovation.
One opportunity that lays wide open out there is the recognition in the OCM model that the NCCN recommendations lead the way in providing innovative off-label uses for drugs and biologics. As a matter of fact, of the first 88 indications for the checkpoint inhibitors, 58% of such indications were based upon NCCN recommendations for off-label uses. The NCCN Guidelines/Drugs-Biologics Compendium clearly represent the standard of care in Oncology in the US. NCCN recommendations are primary drivers of coverage policies of payers/MCOs. As such, under the OCM, new NCCN recommendations for the use of drugs/biologics should qualify for "novel therapies payments" within the OCM program. Limiting such "novel therapies payments" to only FDA approved indications clearly shows either a lack of understanding of the impact of NCCN on coverage policy and prescribing or a resistance to truly accelerate innovation through a payment system that seeks to best satisfy the needs of patients with Cancer.

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