Posts by vihalleh

The Healthcare Round-Up: May 11-18

Posted on Friday, May 18, 2012

Boom time for HCV testing: US health officials released proposed guidelines Friday recommending that all baby boomers should be tested at least once for the hepatitis C virus, which is transmitted through contaminated blood and is often undiagnosed. Infection rates of the silent epidemic have dropped since the 1990s thanks to better blood and organ screening technology, but according to the CDC one in 30 baby boomers (defined as born between 1945 and 1965) are infected with HCV and don’t know it. John Ward, director of the CDC’s viral hepatitis division predict a blood test would identify hundreds of thousands of infections. The proposed guidelines will only fuel the already rampant desires of many biopharmas to become HCV powerhouses. Gilead and Bristol-Myers Squibb are currently duking it out to become the first to offer a non-interferon based regimen, but with new screening guidelines dramatically increasing the treatment pool, expect other companies to look at the space with interest. For payers, meantime, the CDC recs mean more hard choices. With two new hep C drugs on the market – Incivek and Victrelis – payers are already scrutinizing costs in this specialty arena. According to the 2011 Express Scripts Drug report, hep C isn’t in the top 5 costliest specialty trend...

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The Healthcare Round-Up: May 5 – May 12

Posted on Saturday, May 12, 2012

Pharmaceutical Lemonade: Revitalizing “failed” pharmaceuticals isn’t new. Successful medicines like Evista, AZT, Viagra, and thalidomide have all been repurposed. But with pharmaceutical R&D departments under pressure to improve their productivity, the goal of resurrecting drug candidates that may have failed in their first indication is gaining steam—especially if there are ways to do the scientific studies on someone else’s dime. That’s essentially what the National Insitutes of Health is doing with its $20 million grant initiative. Here’s how it works. Three drug companies –Pfizer, AstraZeneca, and Eli Lilly—have donated a total of two dozen molecules previously deprioritized that are known to be safe. Academics interested in studying these compounds further can apply for specific grant funding and have the right to publish non-confidential findings. The academic groups will also retain some intellectual property rights; importantly the company that originally developed the molecule retains rights to the actual compound. The hope is that if researchers find a new use for an old drug, the drug’s originator will see enough promise to license the new intellectual property and fund additional trials. While the consortium includes just three biopharmas now, the NIH hopes other drugmakers will donate additional compounds. It’s hardly surprising to discover Eli Lilly, AstraZeneca, and Pfizer are the initial...

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The Healthcare Round-Up: 4/28 – 5/5

Posted on Saturday, May 5, 2012

Here’s to price transparency: Transparency of procedure and physician costs remains an important initiative as the healthcare industry works to rein in healthcare spending and control the wide price variation seen for similar treatments. On Tuesday May 1, Castlight, which offers a user-friendly tool to compare treatment prices for tests and procedures based on cost and quality, announced it raised $100M in a Series D round­. That’s a huge sum for any privately held life science company. But the figure is especially startling because Castlight falls into the health IT genre, where historically investments have been much, much smaller.  Noted in the Castlight press release, the new round of financing was led by two “major” but unnamed mutual funds, and also included contributions from T. Rowe Price and Redmile Group.  Castlight’s previous investors included standbys like Morgan Stanley, Wellcome Trust, Venrock, Allen & Company and the Cleveland Clinic.  While the financing announcement positions Castlight as the company to beat when it comes to consumer-focused pricing tools, it has plenty of competition, including from payers such as Cigna, WellPoint, and Aetna who are developing tools for their members. —HB Read the Forbes article For an article on changes in consumer behavior, check out this article from the NYT. Read Castlight...

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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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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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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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The Healthcare Round-Up: 3/21 -3/28

Posted on Wednesday, March 28, 2012

All eyes are on Capitol Hill this week as the Supremes hear oral arguments in one of the most important –and politicized—cases in decades: the constitutionality of the Affordable Care Act, the signature piece of legislation passed thus far in Barack Obama’s presidency. It’s anybody’s guess how the Court will vote –questions on day 2 tied to the constitutionality of the individual mandate were pointed and seemed to fluster the administration’s lawyer Donald Verrilli. One thing seems clear: Justice Anthony Kennedy’s view of the mandate will play a crucial role in whether that provision stands. As Scotusblog reports, if Kennedy can find a limiting principle in the federal government’s defense of the insurance mandate or think of one of his own, it could survive—and his arguments just might convince Chief Justice John Roberts to side with the four liberal justices who are already signaling they will support it. But if Kennedy, who expressed skepticism about the mandate, rules against it, the one piece of health reform that insurers really liked will go by the wayside. Whether that scuttles payment reforms already at work by major insurers is another question. Indeed, as CIGNA CEO David Cordani told Bloomberg recently, “With or without the healthcare law, the economic forces are driving...

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The Healthcare Round-Up: 3/14 – 3/21

Posted on Thursday, March 22, 2012

Put a spring in your step and read Real Endpoints’s weekly round-up of reimbursement related news. Overseeing Cancer Drug Regimens: Here’s a scary find.  On March 16 researchers from Medco Research Institute reported new data at the American Society for Clinical Pharmacology and Therapeutics annual meeting showing that a high percentage of patients on oral kinase inhibitors like Gleevec or Tarceva are also taking medicines that reduce the effectiveness of the cancer treatment. In total, the Medco researchers looked at the pharmacy claims of 11,600 cancer patients taking one of nine oral kinase inhibitors during a 29-month period that ended mid-2010. The researchers specifically looked at the secondary drugs prescribed these patients, with an eye for those known to spark potential drug-drug interactions, for instance proton pump inhibitors (PPIs), steroids, calcium channel blockers, and some antibiotics and antifungal treatments.  Based on their analysis, 23-57% of the patients were simultaneously taking a drug that had the potential to reduce the effectiveness of the cancer treatment; even more unnerving, 23-74% of patients received secondary drugs that could have increased the toxic side-effects associated with the cancer medicine.  How could this happen? While oncologists prescribed the vast majority of cancer drugs, other therapies were the purview of primary care physicians; because of...

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The Healthcare Round-Up: 3/7 – 3/13

Posted on Wednesday, March 14, 2012

The Legality of Co-pay cards: It’s no secret co-pay cards are a contentious issue; now, they’ve been taken to the courts. Last week, the consumer advocacy group, Community Catalyst, filed suit against 8 drug companies seeking to ban the use of co-pay cards on behalf of unions that provide drug benefits for civilian and uniformed municipal workers in New York City, carpenters in New England, and plumbers in various states. Among the drug companies specifically named in the lawsuit: Pfizer, which set off the most recent conflagration when it launched its $4 co-pay card for branded Lipitor after the drug’s patent expired this past November.  In its suit, Community Catalyst argues that co-pay cards are an illegal inducement “designed to undermine cost-sharing arrangements.”  In effect, the existence of co-pay cards provides patients with a financial disincentive to use cheaper medicines, while the majority of the bill is still paid for by insurers or pharmacy benefit managers. Community Catalyst’s arguments echo those made by the Pharmaceutical Care Management Agency in a November report estimating that co-pay cards will increase prescription drug costs by $32 billion over the next decade.  Meanwhile, proponents of the practice note that co-pay cards don’t just make things economically feasible for patients; often spending less out-of-pocket...

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