According to the Medco Drug Trend report, by 2015 oncology drug costs will be the second or third costliest class that it tracks, up from seventh in 2011. That’s why, in this relatively unmanaged category, many payers are turning to new cost-containment strategies. Of particular interest: cancer pathways, which standardize therapy based on recognized guidelines and outcomes data, as a vital mechanism to control out-of-control costs. (To attend a free Value & Innovation webinar on … Continue reading
The Healthcare Round-Up: 2/21- 2/28
Weight-loss drug gets advisory committee nod: Can the benefits of weight-loss outweigh the potential costs of severe medical side-effects? An FDA Advisory Committee thinks so. On Wednesday February 22, the Endocrinologic and Metabolic Drugs Advisory Committee voted 20 to 2 to approve Vivus’s Qnexa, a weight-loss pill that combines two previously approved—and now generic—drugs, phentermine and topiramate. It’s been a long and torturous road for Vivus; the company’s backers believe the strong advisory committee meeting … Continue reading
The Healthcare Round-up: 2/14 -2/21
Payers, technology providers, and policy experts are convening in Las Vegas for the annual HIMSS fest to discuss how IT will enable new delivery models and payment reforms that are supposed to improve quality of care and lower costs. The experts are just hoping that what happens in Vegas –from the secure transfer of patient data via iPads and smart phones to the latest technology enabling health information exchanges—won’t stay in Vegas. Meantime, here’s a … Continue reading
Medco Enters Europe: One Company’s Hurdle Is Another’s Opportunity
With falling prices and growing reimbursement hurdles, Europe is the last place most pharma want to be right now. One man’s hurdle is another’s opportunity, though. So it is for Medco, the US-based pharmacy benefit manager, which has recently launched a Europe-focused international operation, underpinned by various legacy collaborations including in Germany, the UK and the Netherlands. The idea: to apply its US expertise and experience in the European context, where different systems and different … Continue reading
So We're All Wrong About NICE?
It seems the National Institute of Clinical Excellence (NICE), referred to interchangeably as “cost-watchdog” and “fourth hurdle”, has been woefully misunderstood. The health technology assessment body for England and Wales hasn’t curbed NHS spend, it has infact pushed it up. “I have never seen NICE as cost-containment organization,” declared its CEO Andrew Dillon at The Economist Pharma Summit in London Feb. 9. Indeed, he continued, “the effect of NICE has been to push the NHS to spend … Continue reading
The Healthcare Round-up: 2/7 -2/13
What’s better than a box of chocolates or a dozen fair trade, organic red roses? A #healthpolicyvalentine. It’s cheaper too. Wonks and journos quickly embraced the nerdy Twitter hash tag created last week by Health and Human Services staffer Emma Sandoe. Notable gems included: Let’s grow Medicare-eligible together I know I am being inpatient, but how about a private exchange? I want to put the oh! in your ACO. Roses are red, violets are blue. … Continue reading
As New Tools Offer Explicit Cost Data on Cancer Treatments, Will Payers Push for their Use?
As we told you in this recent post, a limited number of payers believe one way to better manage the current cancer drug spend is via cancer pathways, essentially a “soft formulary” approach that attempts to standardize care based on publicly available evidence tied to a therapy’s efficacy, toxicity, and cost. Calling 2012 “an inflection point” for cancer pathways, Dr. Ira Klein, national medical director for Oncology Strategy at Aetna, believes “payers have a responsibility … Continue reading
The Healthcare Round-Up: 1/31 – 2/6
Every week Real Endpoints scours the web, the wires, and (sometimes) the weeds for the top reimbursement related news you need to know now. Below are our top picks for the past week. ExpressScripts/Medco: Who would have thunk it? Turns out folks worried that anti-trust concerns might scupper the proposed merger of ExpressScripts and Medco may have been right after all. According to the wire service Reuters, key people at the Federal Trade Commission believe … Continue reading
Payer's Delight: European Drug Prices Could Spiral Downward Thanks To Germany
A little-reported fact about Germany’s new early-benefit assessment system (AMNOG to most people) is that the current law requires making public the rebates agreed to between drug firms and the country’s sick funds association (GKV). That’s a huge departure from the current cozy situation, where only ‘list’ prices are revealed. (That’s the case in most other key markets, too). And it matters to drug firms, since close to 30 countries in the world, including 19 in … Continue reading
Payers Beware: Cancer Pathways Probably Aren’t Enough To Manage Costs
Payers like Aetna and UnitedHealth have a problem. Every year, they spend billions of dollars on their members’ cancer care, and those costs keep going up. And yet, they haven’t felt empowered to actually actively manage this spend. Why? “It’s a sensitive issue,” admits one senior veep at a regional payer. Put simply: no payer wants to end up on the front page of the New York Times for denying a desperately ill patient a … Continue reading