Posts made in April, 2012

The Healthcare Round-Up: 4/20 -4/27

Posted on Friday, April 27, 2012

Last year, Sanofi bought the biotech company Genzyme in a $20.1 billion deal that also included earn-outs tied to the biotech’s promising, albeit risky, multiple sclerosis drug Lemtrada. This week at the 2012 American Academy of Neurology meeting Sanofi reported eagerly awaited head-to-head trial data measuring the efficacy of the Phase III product against competitor Rebif. In a trial designed to drive market access in an increasingly competitive specialty arena, Lemtrada outshone Rebif: twenty-nine percent of patients taking the experimental MS medicine demonstrated a six-month reduction in disability compared with 13% of Rebif patients. Will that be enough to drive physician and payer adoption? The specter of Tysabri looms large in the MS field; a potent medicine, the arrival of Tysabri was heralded as an important advance until the links between its use and a rare, fatal brain disease, PML, became apparent. Safety concerns also continue to dog Lemtrada. Given the safety profiles of existing therapies, especially Biogen’s Avonex and market leader Copaxone (from Teva), physicians are likely to wait until there’s more real world data associated with Lemtrada before prescribing the drug. And waiting in the wings is another drug that could scupper wide-spread uptake of Lemtrada: Biogen’s oral MS candidate, BG-12. Certainly both Lemtrada and BG-12 will...

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Physician Engagement Is Key To Lowering Oncology Costs: A Conversation With Texas Oncology’s Barry Brooks

Posted on Tuesday, April 24, 2012

“Oncology is unique, but it’s less unique than it used to be.” So said Daniel Mullins, a healthcare economist at the University of Maryland School of Pharmacy, during an opening workshop held April 18 at the Academy of Managed Care Pharmacy’s annual event in San Francisco. Such language is an overt acknowledgement that soaring oncology costs are a collective problem for US payers, many of whom are experimenting with evidence-based initiatives like cancer pathways or novel reimbursement plans for providers (or sometimes both). But before they can leverage pathways and bundled care, payers must open their doors to community oncologists and convince them to collaborate. “We’ve got to engage providers and come up with consensus,” admitted Dr. John Cruickshank, chief medical officer of the New Mexico-based payer Lovelace Health Plan at the AMCP meeting. That’s music to the ears of Dr. Barry Brooks, a medical oncologist with Texas Oncology, a community-based practice affiliated with Innovent’s US Oncology. In a recent 15 minute podcast with Real Endpoints, he offers a provider’s perspective on the engagement issue, as well as simple solutions. Brooks is a big fan of cancer pathways and understands why payers believe the concept is a powerful tool to lower oncology costs. But he predicts providers would embrace...

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Risk-Sharing: Not Easy, But Impossible To Ignore

Posted on Monday, April 23, 2012

So risk-sharing deals haven’t taken off with the gusto that their compelling logic suggests they should have. Even in Europe — the ripest territory for such contracts, given the alternative may be no reimbursement at all — there have been only a dozen or so deals. And several of those are mostly about sharing financial risk, rather than tying price or indeed payment to performance and outcomes. The hurdles are better documented than most of the schemes themselves, and most come under the ‘boring but important’ category. Administration. IT systems. Coding complexity. Staff time.  This NEHI roundtable documented them most recently, relegating risk-shares to “exception rather than the rule”. And yet we’re all still talking about risk-sharing. Like a toddler with a tantrum, they’re difficult, but impossible to ignore. Why? Because noone really believes the practical stumbling blocks can stand in the way of what looks to be an increasingly important–if not the only–option for pharmas seeking reimbursement in Europe, especially for their pricey cancer drugs. Think about the alternatives. One is straightforward discounts. They’re already an unofficial requirement for a passage past the health technology assessment body NICE in the UK (given that few companies can meet its requirements for compelling OS data). But as discounts proliferate, so too...

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The Healthcare Round-Up: 4/14 – 4/21

Posted on Saturday, April 21, 2012

The next big data visualization graphic: This week Express Scripts published its annual drug report. The big news: the cost of nonadherence. Indeed, $317 billion of the $408 billion in pharmacy-related waste accumulated in 2011 was due to failed medical adherence, more money than the combined drug costs associated with treating diabetes, congestive heart failure and cancer – combined. Working towards solutions for nonadherence obviously frees up a lot of resources that might be devoted to the coverage of new specialty medicines. (For pharma, it might even be a way to structure a risk-sharing contract. But we digress.) According to a piece in the Wall Street Journal on the growing importance of Big Data, one emerging strategy—and business opportunity—at payers, pharmacy benefit managers, and even providers, is the development of analytic capabilities. Mark it under the mantra “you control what you don’t measure.” Key data intensive areas include not just patient adherence, but also probability of relapse, as well as cost (especially total cost of care). How are different stakeholders using the data? As WSJ spells out, providers such as Health Management Associates and the California physicians group Heritage Provider Network are trying to predict—and hopefully eliminate or avoid—unnecessary hospital readmissions. Express Scripts wants to improve adherence to medications,...

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The Healthcare Round-Up: 4/6 – 4/14

Posted on Saturday, April 14, 2012

First ACO’s under Medicare’s Shared Savings Program:  In addition to TEDMED, which this week gathered healthcare luminaries to discuss all things innovative, ACO was the other au courant acronym of the news cycle. Even as debate swirls about the fate of the healthcare reform law, there’s an obvious need to better coordinate healthcare, with ACOs being a topic of rare bipartisan politicking.  Thus, its no surprise that accountable care organizations are alive—and growing rapidly—in numbers. On Tuesday, April 10 the Center for Medicare & Medicaid Services announced 27 healthcare organizations will participate in their Shared Savings program, while another five have signed on as advanced payment ACOs. According to the press release from CMS, the new ACOs will serve an estimated 375,000 patients across 18 states; that means together with the 32 pioneer ACOs, there are now 65 accountable care entities serving more than 1 million Medicare patients. But those numbers could quickly swell; some 150 other groups have applied to participate in the Medicare Shared Savings program starting in July. Moreover, a survey of more than 350 health executives released in the April issue of HealthLeaders finds provider interest in the concept is extremely high, with 39% of individual surveyed planning to implement or join an ACO in...

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England Edges Toward National Cancer Tariff

Posted on Friday, April 6, 2012

April marks the start of an ambitious, if overdue, data collection project in the UK that could ultimately lead to England’s National Health Service paying a series of pre-determined tariffs for cancer drug procurement and delivery across all segments of the disease. If such standardized pricing materializes, the implications for pharma would be significant. The tariff idea isn’t new, and already exists for most acute services in England. But its expansion into areas such as cancer has been held up by poor data and inadequate IT systems – deficits affecting many other progressive steps related to upgrading healthcare delivery. To address both these shortcomings, a nationwide chemotherapy data collection plan will begin in April 2012. At least half of England’s 150 or so regional payers (Trusts) will have to input information about all patients receiving NHS-funded chemotherapy into a centralized data repository based in Oxford called the Chemotherapy Intelligence Unit. The CIU will ultimately help generate a series of fixed, average prices that the NHS would use to reimburse Trusts for delivering cancer treatment. It would also create another set of tariffs (ten bands covering a spectrum of regimen-costs) tied to the procurement of cancer drugs. These tariffs would reflect average procurement costs collected from across the country, not...

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The Healthcare Round-Up: 3/28 – 4/4

Posted on Thursday, April 5, 2012

Reducing unnecessary care: On Wednesday April 4, nine physician societies, together with the ABIM Foundation and Consumer Reports, released a list of 45 procedures or tests (5 per specialty) that are overused and adding to soaring healthcare costs as part of a new educational initiative called Choosing Widely. Another 8 specialty boards are preparing lists of relevant tests their members should be more judicious about ordering. Once again it’s a reminder that there’s growing support for the idea that in certain areas of healthcare it’s critical to embrace a “less is more” mentality. Among the tests garnering extra scrutiny: CT scans for chronic sinusitis, dual energy X-ray scans for osteoporosis in women younger than 65, and MRIs to evaluate lower-back pain. But given the grievous nature of cancer, it’s the recommendations by the American Society of Clinical Oncology that could prove most controversial, especially guidance to avoid chemotherapy use in advanced cancer patients who are unlikely to benefit. As Sharon Begley of Reuters reports, ASCO’s recommendations were driven by medical considerations, but, importantly, cost was also a major factor.  The NYT suggests doctors will be more likely to embrace the notion of doing less since the guidelines come directly from physician groups (as opposed to a government sponsored organization...

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