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We examine the recommendations of the President’s Cancer Panel to reduce the economic burden for cancer patients and their families.

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Mar. 16, 2018

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FEATURED STORY
 

Cinderella Dreams: Recommendations for Value in Oncology Treatment

 
 

In a report to the White House released Monday, an independent advisory group called for “urgent action” to address rapidly rising prices for cancer drugs and the economic burden cancer patients and their families can face because of the high cost of cancer care.

Established by law in 1971 as part of the National Cancer Act, the President’s Cancer Panel is tasked with identifying barriers to progress in reducing the burden of cancer in the US, and delivers regular reports to the White House. This year, the report focuses heavily on pricing, in line with Donald Trump’s own statements on the pharmaceutical industry.

The panel issued 6 recommendations to ensure alignment of drug prices with drug value, promote use of high-value drugs, and support innovation in cancer drug development. The main themes of the report dovetail with Health and Human Services (HHS) Secretary Alex Azar’s remarks last week that the shift to value-based care will have to “accelerate dramatically.” These recommendations are merely policy suggestions not indicative of potential legislation or regulatory action by the Administration.



As outlined through its recommendations, the panel offers several strategies for the President and other stakeholders to consider to align the value of cancer drugs with cost, provide affordable access to appropriate cancer drugs for patients, and encourage innovation in cancer drug development—all while avoiding the financial toxicity to patients that may ultimately reduce the quality of life and overall health outcomes.

 

Payer Tactics to Manage Commercial Copay Assistance

 
 

The prices for brand-name prescription drugs—particularly those products deemed as specialty drugs—continue to soar, leading to health insurance plans in the commercial (private market) sector exploring ways to manage these drugs more aggressively.

Patients may end up bearing the brunt of these market dynamics, often facing high out-of-pocket (OOP) costs for these drugs. Xcenda examines the payer tactics to manage copay assistance in a new issue brief. Download now

 
 

 
LEGISLATIVE UPDATES
 

Schooling the Opposition and Scoring 8%

 
 

Yesterday, the Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing to discuss perspectives on the 340B Drug Discount Program that offers non-profit hospitals and clinics significant savings on drug acquisition costs.

The program has come under fire in recent years from critics who say eligible facilities are not using all of the program revenue “to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.” This practice, they believe, provides these facilities additional revenue that is not used to support indigent care but instead is just profit. Additionally, the critics also point out the lack of transparency in how hospitals are using profits from the program.

An interesting exchange occurred when representatives of America’s Essential Hospitals and the Pharmaceutical Research and Manufacturers of America (PhRMA) could not agree on total amount of 340B discounts. America’s Essential Hospitals’ President said it was 1.3%, while PhRMA’s Executive Vice President for Policy, Research, and Membership countered with 8% of drug spending. HELP Committee Chair Lamar Alexander (R-TN) pointed out the yawning gulf between the 2 figures, stating that a 1.3% discount is an acceptable tax if used for a “good purpose.” He felt an 8% discount, on the other hand, would be “a pretty big tax on the pharmaceutical, on any business, particularly on revenue.”

The hearing was to help the Senate better understand different sides of debate around the 340B program and gauge how the program may have evolved since its inception. Manufacturers have asked for changes, and the Trump Administration has signaled its interest in narrowing which facilities are eligible for 340B and requiring more oversight. Sen. Alexander indicated he would hold at least 1 more hearing on the issue.

There are harbingers that changes may be coming for the 340B program. In November, the Centers for Medicare & Medicaid Services (CMS) dramatically reduced its payment to hospitals for 340B drugs, and the House is considering a package of bills to limit the patients qualifying for the discount, and would expand reporting requirements for how hospitals use program funds.

 

Legislative Bytes

 
 
  • House Republicans failed Tuesday evening to pass a right-to-try bill that would have given terminally ill patients access to experimental drugs without FDA authorization.
  • Sen. Lamar Alexander (R-TN) is circulating a 2-page summary of preliminary Congressional Budget Office (CBO) projections of language he has developed with Sens. Patty Murray (D-WA) and Susan Collins (R-ME) to stabilize the Affordable Care Act (ACA) insurance exchanges that could reduce premiums by an average of 10% in 2019 and by 20% in 2020 and 2021.
 

Xcenda Collaborates With Family Reach on Critical Issue: Cancer-Related Financial Toxicity

 
 
Our in-depth white paper shines a spotlight on a national crisis impacting cancer patients and their families.

Xcenda consultants lent their scientific research, medical writing, and design expertise to collaborate on a white paper spearheaded by Family Reach, titled Cancer-Related Financial Toxicity and Its Pervasive Effects on Patients and Families: Solving a National Health and Economic Crisis Hiding in Plain Sight. Learn more

 

 

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REGULATORY UPDATES
 

An Alley Oop From the PCSK9s

 
 

Over the weekend, Sanofi and Regeneron announced they would offer a reduced net price for their cholesterol-lowering PCSK9 inhibitor, PRALUENT (alirocumab), in exchange for US payers easing restrictions on access. The announced price cut comes alongside favorable results of their ODYSSEY study, which demonstrated a reduced risk for major adverse cardiac events, as well as mortality.

Despite these findings, however, the Institute for Clinical and Economic Review (ICER) released an updated cost-effectiveness analysis for the drug, placing its cost-effectiveness at well below its list price. ICER’s analysis determined that a discount of potentially greater than 50% off the list price would be required to consider PRALUENT cost-effective.

The uptake of PRALUENT, as well as other PCSK9 inhibitors, has fallen short of blockbuster expectations, as insurers are weary of high price tags and have been enforcing usage only for indications approved by the Food and Drug Administration (FDA). The effects of these new data and Sanofi’s willingness to lower PRALUENT’s price remains to be seen. In the meantime, ICER indicated it will issue a final New Evidence Update for PRALUENT by May 3, 2018.

ICER also announced this week that it was requesting public comment on 2 draft scoping documents on treatments for high-risk prostate cancer and amyloidosis.

 

Tip Off to Those Who Don’t Follow Healthcare: We Spend a Lot

 
 

According to a new report by IQVIA, all spending growth in 2018 will come from specialty medications, while spending on traditional medications is slated to drop over time. Specialty drugs are expected to consume 48% of spending in developed markets by 2022.

This report documents the dramatic effects specialty drugs are having in today’s healthcare system. Specialty drugs generally have few competitors, thus removing a powerful weapon payers have to counteract high prices. However, IQVIA warns that some specialty drugs “may not produce significant financial returns” due to the growing resistance of payers, despite the greater clinical benefits.

An article published in JAMA this week showed the US spends about twice what other high-income nations do on healthcare. More doctor visits and hospital stays are not the problem, the study found. Rather, Americans use roughly the same amount of health services as people in other affluent nations, but US spending may be higher because prices are steeper for drugs, medical devices, salaries, and administrative costs to process medical claims.

The information from IQVIA and JAMA points to the need not to look at the spending on healthcare line items in a vacuum, as they are twined together and cannot be easily separated. However, drug prices are readily available and are easy targets.

 

Information Buffet (AKA, Other Stuff That Caught Our Attention)

 
 

We kept running into stories we wanted to bring to your attention, so here’s a quick hit list of other news we thought you should know:

 
HEARD ON THE STREET
 

“Seizing…assets [from notorious pharmaceutical executive Martin Shkreli] worth a total of $7.4 million may seem like karma, but it will do nothing to tame drug costs. Indeed, it is entirely legal to raise generic drug prices (which explains why Shkreli was convicted of securities fraud, not healthcare fraud). The problem is that government has made it far too easy for pharma companies to gain a national monopoly on the supply of drugs that no longer are patent-protected. Rather than make an example of Shkreli, the solution to outrageous drug prices is to embrace globalizations.”

 

– David A. Hyman, adjunct scholar at the Cato Institute and a professor at the Georgetown University Law Center, and Charles Silver, law professor at the University of Texas at Austin, arguing that competition is the best remedy for price gouging

Source: “Jail Time for Martin Shkreli Won’t Fix Drug Prices. Globalization Will,” Los Angeles Times, March 15

 
POLICY BY NUMBERS
 

From 90% to 42%

 

Support for Medicare negotiations with pharmaceutical manufacturers dropped from 90% to just 42% when respondents to a POLITICO-Harvard T.H. Chan School of Public Health poll weighed the risk that some drug makers might respond by halting the sale of certain drugs to seniors. Additionally, while 80% of survey respondents favored limiting the price of drugs sold to state health programs, only 38% still approved if it meant manufacturers would spend less on research and development.

Source: “Americans’ Views of President Trump’s Agenda on Health Care, Immigration, and Infrastructure,” POLITICO, March 14

 
UPCOMING MEETINGS & CONFERENCES
 

AMCP Managed Care & Specialty Pharmacy Annual Meeting

April 23–26 l Boston, MA
Join AmerisourceBergen companies, US Bioservices and Xcenda, at AMCP’s Annual Meeting at the Boston Convention and Exhibition Center, April 23–26. Meet with our specialty pharmacy and commercialization experts at the largest gathering of managed care professionals who work, lead, and innovate in the ever-changing world of pharmaceutical management. Visit AmerisourceBergen at booths 316 and 321. Learn more

 

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Count on Health Policy Weekly for an at-a-glance view of legislative and regulatory developments and news that impacts the healthcare industry.

 
 
 
 

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FEATURED CONTRIBUTORS
 

EDITOR-IN-CHIEF:
Jennifer Snow
Senior Director,
Health Policy
Xcenda

MANAGING EDITOR:
Scott Shields
Associate Director,
Health Policy
Xcenda

 

ADVISORY BOARD:

Peyton Howell, MHA
Executive Vice President & President, Health Systems & Specialty Care Solutions | AmerisourceBergen Corporation

Amy Grogg, PharmD
Senior Vice President | Strategy & Commercialization | AmerisourceBergen Corporation

Kristine Flemister, PharmD
President | Xcenda

Tommy Bramley, PhD, RPh
President | Lash Group

Stacie Heller
Vice President | Government Policy | AmerisourceBergen Corporation

Rita Norton
Senior Vice President | Government and Public Policy | AmerisourceBergen Corporation

Ana Stojanovska
Vice President | Reimbursement & Policy Insights | Xcenda

CONTRIBUTING AUTHORS:

Andrew Gaiser | Katherine Bridges Maness | Josh Olivero | Scott Shields | Aileen Soper 

PRODUCTION:

Laurie Kozbelt | Ellen Olson | Tia O’Brien

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Mar. 16, 2018

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