Power to the payer. Just weeks after a team of Memorial Sloan Kettering Cancer Center physicians criticized the high price tag of Sanofi/Regeneron’s new angiogenesis inhibitor Zaltrap in a New York Times editorial, the manufacturers responded by cutting the drug’s price in half. In a statement sent to media outlets, Sanofi emphasized its decision to reduce Zaltrap’s price tag was rooted in a desire to ensure patient access to the medicine, and cited “market resistance” … Continue reading
Hurricane Sandy Disrupts “The Disruptors”
At Real Endpoints, we know the importance of showing mothers respect – especially Mother Nature. It took a storm the magnitude of Sandy to disrupt “The Healthcare Disruptors”. But with a hurricane wrapped in a Nor’easter bearing down on the East Coast – and continued uncertainty about what the coming days may bring – the wisest course of action was to postpone the Real Endpoints Symposium until 2013. We had a committed audience attending – … Continue reading
Sloan-Kettering Fires A Shot at High-Priced Marginal Cancer Drugs
No. It’s such a little word, but that doesn’t make it any easier to say. And nowhere is that more obvious that when it comes to cancer care, as Memorial Sloan-Kettering Cancer Center physicians Bach, Saltz, and Wittes point out in their provocative NY Times op-ed, “In Cancer Care, Cost Matters”. “Our medical culture equates ‘new’ with ‘better’ so unequivocally,” the authors note. Yet that hasn’t stopped them from outlining so convincingly how the evidence … Continue reading
Clinical Utility: An Ever Higher Bar To Clear For Molecular Diagnostics
Before covering a pricey molecular diagnostic, payers want proof that the test in question is both efficacious and adds new therapeutic value. As Dr. Ira Klein, Chief of Staff to Aetna’s Chief Medical Officer, told Real Endpoints in this recent podcast “we have to understand that the test gives the member or doctor actionable information.” What Klein and execs at other payers want are data concretely linking a particular test to improved outcomes and health … Continue reading
Sliding Away From Fee-For-Service: How CareFirst Does It
There’s been a lot of talk about the pros and cons of the standardization that comes from “Cheesecake Factory” style medicine since Atul Gawande published his thought provoking New Yorker piece. Like it or not, forward-thinking physician practices and payers are already embracing the concept. In oncology, look no further than John Sprandio, president of Consultants in Medical Oncology and Hematology and a pioneer in the oncology patient centered medical home movement, and Winston Wong, … Continue reading
The Prostate Cancer Battle: Can Xtandi’s Convenience Support a Premium Over Zytiga?
It may be Orion/Endo’s ODM-201, a potentially first-in-class anti-androgen to treat metastatic castration-resistant prostate cancer, that’s generating the most buzz ahead of this weekend’s European Society of Medical Oncology (ESMO) meeting in Vienna. But payers and physicians have a much more pressing concern: how to objectively evaluate two competing anti-androgens, Janssen’s Zytiga and Medivation/Astellas’s newly approved Xtandi, already on the market to treat advanced prostate cancer in the post-chemotherapy setting. A review of peer-reviewed published … Continue reading
Abraxane: The Canary in the Oncology Reimbursement Coal Mine
When it comes to oncology drugs, payers are lousy at saying no. There are good reasons for this, including state mandates and fear of public/political backlash. But none will help curb costs. So if payers know they can’t realistically say yes to everything anymore, in which instances can they say no — and not be pilloried? Abraxane is a reasonable place to start. It’s basically a patient-friendlier version of one of oncology’s old-standbys, the chemotherapy … Continue reading
Managing Molecular Diagnostics: The View from Aetna’s Ira Klein
What could be more intuitive than providing the right medicine to the right patient at the right time? Alas, the actual implementation of personalized medicine is frustratingly imprecise—and, increasingly, expensive. And that’s a big concern for payers who wrestle with questions of cost, and what constitutes clinical validation and utility when making diagnostic coverage decisions. Not only is it a topic of discussion at our inaugural Real Endpoints Symposium (taking place November 1-2 in Philadelphia). … Continue reading
The Healthcare Round-Up: August 3 -19
The Olympics (and shark week) are over, the dog days have officially arrived, and here at the West Coast branch of Real Endpoints, it’s back to work as the little people head back to school. (Already!) Given Mitt Romney’s choice of Paul Ryan as his running mate, it’s a sure bet healthcare (especially Medicaid and Medicare) will remain a subject of debate in the run-up to the presidential election. So will the subject of “big … Continue reading
Are Choppy Reimbursement Waters in the Forecast for Oncotype Dx?
Genomic Health’s Oncotype Dx, a 21-gene assay to predict breast cancer recurrence and chemotherapy response, is one of the market leaders in the brave and expensive new world of molecular diagnostics. Influential payers like Medicare and Blue Cross Blue Shield have endorsed the test, which lists for more than $4000; powerful societies like the National Comprehensive Cancer Network and the American Society of Clinical Oncology have also given the diagnostic their blessing. Meantime Oncotype Dx’s … Continue reading