OBR Daily Commentary

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Surprise Federal Drug Rule Directs Insurers to Reveal What They Pay for Prescription Drugs

(KHN) Nov 19, 2020 - Health insurance companies will have to give their customers estimated out-of-pocket costs for prescription drugs and disclose to the public the negotiated prices they pay for drugs, under an unexpected new Trump administration rule.

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Dean Gesme, MD (Posted: November 19, 2020)

quotesDisruption rather than transparency. This rule, to take effect in 2022, will allow commercially insured patients to see the negotiated contractual "price" that insurers/PBMs pay to drug manufacturers but excludes rebates and other incentives which are necessary for consumers to make meaningful comparisons between insurance plans. quotes

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CMS Coverage Draft Shuns 1st-to-Market Colorectal Cancer Blood Test, Outlines Path For Exact, Guardant

(MedTech Dive) Oct 20, 2020 - Under a proposed CMS coverage policy for blood-based screening tests for colorectal cancer, the first such FDA-approved assay sold by Epigenomics failed to meet criteria for Medicare beneficiaries.

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Dean Gesme, MD (Posted: October 21, 2020)

quotesBlood-based cancer screening appears now to be the “holy Grail” (pun intended) of early cancer diagnosis and treatment. Commercial and governmental payment for these expensive tests will be the primary determinant for the viability of these Patient-friendly diagnostics. This CMS coverage draft seeks to establish critical threaseholds for the Corporate success of these easier screening modalities in this accelerating medical market space!quotes

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With Election Looming, Trump Releases Major, Last-Ditch Drug Pricing Order

(STAT) Sept 13, 2020 - President Trump released an executive order Sunday that would drastically cut how much Medicare pays for virtually all of the drugs seniors take — the boldest move yet he’s taken to lower drug prices since taking office. The policy vastly expands an older, controversial drug pricing policy that Trump has been teasing for months. Effectively, it will force drug makers to offer their medicines to Medicare at the same prices they do in other countries, as a so-called most favored nations policy.

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Dean Gesme, MD (Posted: September 14, 2020)

quotesTrump, by Executive Order, invoked his International Pricing Index for BOTH Medicare Part B and Part D as a 5 year demonstration project. It will now require rule-making and legal scrutiny by affected parties but is likely meant primarily as a vote magnet for Seniors.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 Professo...

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

Steven Spielberg Family Chair in Hematology Oncology P...

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Stephen M. Schleicher, M.D., MBA

Community Oncology, Medical Oncologist, OneOncology...

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 ...

Health Policy
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William McGivney, PhD

National Health Policy Expert...