Medicare Part B patients could experience significant access barriers with the use of single-value threshold methodologies to set coverage or payment policies. Learn more.

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June 1, 2018


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Editor’s Note: It’s a short week, and other than the President signing Right to Try legislation (covered in last week’s issue) and foreshadowing voluntary drug price reductions (reality TBD), we decided to do something different and bring you some new original research and a recap of other work we’ve released over the past few months. Back to regularly scheduled programming next week.


Diving Into the What-Ifs of ICER:
Implications of Applying Cost-Effectiveness Thresholds in Medicare


Continued concerns about rising healthcare costs have prompted renewed proposals for use of a single value threshold (eg, cost-effectiveness threshold or similar approaches) as the basis for setting coverage or payment policy.

To further inform debate about the role and implications of value standards in healthcare policy, Xcenda examined the potential impact if the Institute for Clinical and Economic Review’s (ICER’s) value assessment framework was applied across 4 conditions in the Medicare Part B program. Xcenda selected ICER’s framework because it appears designed for use at the policy level, was referenced in Medicare Payment Advisory Commission (MedPAC) deliberations, and was cited by the Centers for Medicare & Medicaid Services (CMS) in its controversial 2016 Part B Drug Payment Model proposal.

Our study looked at the over 200,000 Medicare Part B fee-for-service beneficiaries with rheumatoid arthritis, multiple sclerosis, non-small cell lung cancer, and/or multiple myeloma who used a physician-administered product evaluated by ICER. If the Medicare program was to adopt an ICER-based formulary, 59% to 93%, or nearly 140,000 of these patients, could lose access to their physician’s treatment of choice and could be forced to switch to a therapy deemed cost-effective.

Our results underscore the importance of ensuring that value assessments are used in ways that do not prevent patients and doctors from making informed choices about care options and the need for alternatives that are more physician- and patient-centered. Ideally, current or alternative tools could be tailored and supported that encourage informed, individualized decisions at the physician and patient level.

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On-Demand Webinar: The Emergence of Copay Accumulator Programs: Recent Research and Its Potential Impact on Patients


The accumulator model presents new challenges to patients and manufacturers as it continues to gain traction among pharmacy benefit managers (PBMs). Join experts Jim Dickey, Director, Product Experience from Lash Group, and Corey Ford, Director, Reimbursement Strategy & Tactics from Xcenda, in an on-demand webinar as they present exclusive research findings on copay accumulator programs and their impact on manufacturers and patients.

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State-Led: The Push for Transparency in Drug Pricing


A lack of progress at the federal level, coupled with the public demand for action, is compelling many states to act on drug pricing legislation. Xcenda examines current state-level activity and impacts in our latest issue brief.

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Rethink: Payer Strategies for Commercializing Cell and Gene Therapies


Cell and gene therapies present a new frontier for medical advances. But with that frontier comes a host of new questions about how to gain coverage for products to drive access and ensure a clear path to treatment.

Xcenda surveyed 46 executives from managed care organizations, pharmacy benefit managers, and similar organizations to discover how they are evaluating the cell and gene therapy space. The insights show a market that’s not yet fully aligned around how it will approach coverage for cell and gene therapy products—which presents ample opportunities for cell and gene therapy innovators to shape payers’ thoughts and decision making in this burgeoning therapeutic class.

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Seeing the Value and Transparency of Medicare Part B


As the largest payer of healthcare services in the United States, CMS often sets trends for healthcare delivery and reimbursement.

Our health policy experts examine 4 areas where they think Medicare has got it right: reimbursing physician-administered drugs, enabling beneficiary choice through Medicare Advantage, looking at total cost of care, and tying payment to quality.

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Payer Tactics to Manage Commercial Copay Assistance Gaining Traction


Manufacturer-sponsored copay assistance programs exist to ease the often significant financial burden on patients.

As more commercial payers assess copay programs for their impact on cost and formulary management, plans and PBMs may target—and restrict—financial assistance. Xcenda shares results from a survey of 46 national and regional commercial plans in this issue brief.

Learn more >

HPW Rebuild


Manufacturer Survey: Proactive Communication of HCEI


We want to hear from you.

We invite manufacturer partners to participate in a survey regarding policy impacts on proactive communication of healthcare economic information (HCEI). Participants will receive a copy of the survey results once available and are eligible for a drawing for a pair of Apple AirPods!


2018 ASCO Annual Meeting

June 1–5 l Chicago, IL
AmerisourceBergen is proud to support this year’s ASCO Annual Meeting where more than 38,000 attendees from around the world gather to gain informative educational insights and listen to scientific sessions that highlight the latest in cancer care treatments. Visit AmerisourceBergen at booth #19135. Xcenda is also proud to co-author 2 posters presented at the event: Comprehensive tumor genomic testing in the community oncology setting in the United States (abstract #e24304) and Current real-world treatment patterns and outcomes in patients with relapsed/refractory multiple myeloma (abstract #e20038). Learn more


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


Jennifer Snow
Senior Director,
Health Policy

Scott Shields
Associate Director,
Health Policy



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


Kylie Matthews | Ellen Olson


June 1, 2018


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