Budget Deal Passes Senate; Site-Neutral Medicare Payments a Reality

President Obama will now sign into law the budget deal, passed early this morning by Congress, which creates site-neutral payments for hospital outpatient departments and independent community cancer clinics. COA supported this provision in the budget deal and worked hard in justifying it. Executive Director Ted Okon was quoted in the DC/Hill publication Inside Health Policy as saying that, “Medicare should not subsidize emergency care with a system that encourages hospitals to buy private physician practices so they can charge more for physician services.” Okon noted that congressional Medicare payment advisers recommended similar site-neutral policies. Cancer doctors are not the focus of the site-neutral measure, but oncology services are a good example of the pay disparity between hospital outpatient and physician offices, Okon said. It’s common for patients to be hit with significantly higher bills for chemotherapy from one cycle to the next because in the interim a hospital bought the practice, even though they’re receiving chemotherapy at the same office, staffed by the same providers. “It’s about time,” Okon said of the site-neutral policy.

There is a good review of the site-neutrality provision in the next story from The National Law Review in Breaking News.

If A New Cancer Drug Is Hailed As A Breakthrough, Odds Are It’s Not

Miracle. Game changer. Marvel. Cure. Lifesaver.

For Dr. Vinay Prasad, each one of these words was a little straw on the camel’s back. At oncology conferences, they were used “indiscriminately” to describe new cancer drugs. Journalists bandied them about in stories.

Finally, the pile of hyperbole broke the camel’s back. (more…)

Novartis, Juno Face Production Hurdles for New Blood Cancer Drugs

As drugmakers including Novartis, Juno Therapeutics and Kite Pharma race to launch what may be the most effective treatments ever seen for leukemia and other blood cancers, they are grappling with how to make them widely available in a reliable and cost-efficient way.

The new therapies, known as CAR T cells, are made by extracting immune system T cells from an individual patient, altering their DNA to sharpen their ability to spot and kill cancer cells, and infusing them back into the same patient. In some early-stage clinical trials, the treatments eliminated all trace of leukemia and lymphoma in 40 percent to 90 percent of patients who had run out of other options. (more…)

Philidor Said to Modify Prescriptions to Boost Valeant Sales

A specialty pharmacy that fills prescriptions for Valeant Pharmaceuticals International Inc. has altered doctors’ orders to wring more reimbursements out of insurers, according to former employees and an internal document.

Workers at the mail-order pharmacy, Philidor RX Services LLC, were given written instructions to change codes on prescriptions in some cases so it would appear that physicians required or patients desired Valeant’s brand-name drugs — not less expensive generic versions — be dispensed, the former employees said. Typically, pharmacists will sell a generic version if not precisely told to do otherwise by a “dispense as written” indication on a script. The more “dispense as written” orders, the more sales for the brand-name drugmaker. (more…)

More Evidence That Drinking May Raise Breast Cancer Risk

European study found odds for the disease rose along with daily consumption

A new study out of Europe supports the notion that drinking raises women’s risk of breast cancer.

Researchers from five Spanish universities looked at data on more than 334,000 women aged 35 to 70, across 10 European countries. Nearly 12,000 of the women developed breast cancer over the study period. (more…)

Payment Reform Pilot Updates at the COA Payer Summit

ayer-provider teams presented updates on their cost-saving pilot projects and looked to the future of these models in oncology care.

An ageing population, technological innovation, increased awareness resulting in earlier screening, and improved treatment regimens that have made cancer a chronic disease in some cases—all of these factors together lend a significant contribution to the growing cost of oncology care. In an attempt to curb this increasing financial burden on the US healthcare system, several payment reform pilots are being evaluated by payers in collaboration with their clinical care partners. At the third Payer Summit hosted by the Community Oncology Alliance (COA), payers and providers took to the stage to provide a progress report and discuss some of the challenges and lessons learnt along the way. (more…)

Community Oncology Alliance Hosts Third Summit on Cancer Care Payment Reform

The Community Oncology Alliance (COA) hosted nearly 200 payers, providers, and industry leaders this week for a discussion on oncology payment reform at the Payer Exchange Summit III. This marks COA’s third payment reform convening in the last year and represents community oncology’s continued leadership in developing innovative solutions for America’s healthcare system. (more…)

Community Oncology Alliance Applauds Inclusion of Medicare Payment Site Neutrality in Budget

The Community Oncology Alliance (COA) applauds Congress for including a fix to the disparity in Medicare payments to hospital outpatient departments and physician offices in their bipartisan budget deal. The site-neutral payment fix will result in lower costs for seniors, especially with cancer, the Medicare program, and taxpayers. Starting in 2017, Medicare will pay identical rates for critical cancer care services, such as the administration of chemotherapy, whether provided in physician-directed community cancer clinics or hospital outpatient departments. (more…)

Cancer Hits Americans in the Wallet, Study Finds

The average U.S. adult diagnosed with cancer will miss five weeks of work in the first year and see total family income decline by 20 percent, according to a new study.

Those numbers may be even higher for some, as they average the experiences of people with various types and stages of cancer, and those who started out working full-time along with those who were not employed to begin with, the authors explain. (more…)

Landmark Clinical Trial Shows Gene-Targeted Drug Can Treat Prostate Cancer

A pioneering drug developed to treat women with inherited cancers can also benefit men with advanced prostate cancer, a major new clinical trial concludes.

The trial is a milestone in cancer treatment as the first to show the benefits of ‘precision medicine’ in prostate cancer – with treatment matched to the particular genetic characteristics of a man’s tumour. (more…)