Car-T Affordability and Access Alert Issued by ICER in Recent Report

Posted April 5th, 2018 by Be The Match and filed in Payer Policy
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The Institute for Clinical and Economic Review (ICER) recently released a summary report analyzing the clinical and cost-effective benefit of two emerging CAR-T therapies approved by the FDA in 2017:  tisagenlecleucel (Novartis) and axicabtagene ciloleucel (Kite/Gilead).

The report concluded that there was a “net health benefit compared to standard chemoimmunotherapy” as well as stating that both therapies are determined to be “cost-effective in the long term for the specified indications,” (adults with Non-Hodgkin’s Lymphoma and pediatric patients with B-ALL).  However, ICER issued an “affordability and access alert” as part of the final report since findings showed that “the added health care costs may be difficult for the system to absorb over the short term” and that “only 38% of the eligible population of 5,900 could be treated before crossing the affordability threshold.”

The report concludes with key policy recommendations to address affordability and access.  Below is a sample of those policies that should be implemented by payers:

  • Manufacturers, public and private insurers, and providers should meet prior to FDA approval to address uncertainty regarding payment arrangements, a step that will reduce unnecessary delays in delivering care to patients and financial uncertainties for insurers and providers.
  • Value-based pricing should be viewed in context with the affordability of a new treatment based on the size of the population eligible to receive the therapy.
  • Manufacturers and insurers should ensure that outcomes-based pricing arrangements are linked to meaningful clinical outcomes assessed with sufficient follow up.

For additional information, please see the full report.

NMDP Advisory Group on Barriers to Transplant (AGBT) Update

Posted April 5th, 2018 by Be The Match and filed in Payer Policy
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The National Marrow Donor Program (NMDP)Advisory Group on Barriers to Transplant (AGBT) recently met for a full day during Tandem this past February in Salt Lake City, Utah.  This group of accomplished and influential national leaders serves NMDP’s Board of Directors by addressing system issues that could be improved through the collaborative efforts of the transplant provider and health insurance communities.  The group is co-chaired by Dr. Nandita Khera, Medical Oncologist with Mayo Clinic and Dr. Jim Coates, Senior Medical Director of Aetna’s National Medical Excellence Program.

The 2018 group is currently comprised of commercial payers, transplant center administrators, and medical directors  who have an interest in improving access barriers to transplant for patients. Organizations such as Optum, University of North Carolina, Children’s Healthcare of Atlanta, Oregon Health, Interlink Health Services, Anthem, Kaiser Permanente, City of Hope, Sarah Cannon, HRSA, University of Miami, Dana Farber, Cigna, Memorial Sloan Kettering LifeTrac, Northwest Marrow Transplant Program and the Cleveland Clinic are represented this year and we are very fortunate to have them advising our work.

Below is a sneak peek into some of the priorities and projects that emerged during the meeting:

Care Coordination Work Group Update:  The care coordination work group is co-chaired by Dr. Khera and Pat Martin, Anthem’s Specialty Network Director.  This group is charged with identifying challenges and opportunities to improve the coordination of care across the transplant continuum.  The group gave an update on a toolkit being launched that will provide guidance and resources for patients, providers, payers and other transplant center staff as they journey together across the continuum of care for transplant.  Starting with diagnosis and ending with survivorship, the toolkit addresses what typically becomes missed opportunities to educate patients about key aspects of the transplant process.

Timely Referral Work Group Update:  The timely referral work group is currently chaired by Julie Walz, Healthcare Executive consultant formerly with MultiPlan and Dr. Bill Wood, Assistant Professor and Hematologist from UNC Health Care.  This group is charged with identifying challenges and opportunities to improve the timely referral of individuals to transplant.  The group discussed the need to influece hard to reach providers in the community who are not integrated into a health system with a transplant center.  There was agreement that payers may have a role to play in supporting NMDP’s efforts to improve targeted education and outreach to providers in order to improve timely access to transplant.

2018 Priority Highlight:  The advisory group’s priority for 2018 includes understanding the financial toxicity for patients. Financial toxicity describes the out of pocket costs associated with transplant evaluation, treatment and survivorship.  It includes costs payers typically define as co-pays, co-insurance, and deductibles among others.  There was agreement within the group that NMDP is well-positioned to partner with transplant centers and payers to implement a policy and research agenda that will systematically remove financial barriers pre and post-transplant.

The advisory group will be meeting this spring and the care coordination toolkit posted online soon so stay tuned for more updates!

Upcoming Conference: Timely Referrals Presentation at OptumHealth Conference

Posted April 5th, 2018 by Be The Match and filed in Payer Policy
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Dr. Linda Burns, Vice President and Medical Director for the National Marrow Donor Program, will be speaking at the OptumHealth Education “Transplantation: Essentials of Oncology, Solid Organ and Blood/Marrow Transplant Management for the Health Care Team” conference to be held in April at The Scott Resort & Spa in Scottsdale, Arizona on April 15-16.  The title of her presentation is “The Impact of Timely Referrals for Blood/Marrow Transplantation on Patient Outcomes and Transplant Success.” Dr. Burns is also a member of the CIBMTR Executive Committee.  OptumHealth Education is a joint accredited provider to provide continuing education for the healthcare team. This conference agenda is varied to provide an in-depth exploration of emerging technologies and trends in oncology and transplantation. Past attendees have included medical directors, nurses, pharmacists, case managers and medical management staff from payer and employer organizations throughout the United States.

We will be exhibiting at this year’s conference so be sure to look for us if you are attending.  We will have a table full of resources including information about our patient support programs, sample patient education materials, reimbursement and billing guides, transplant fact sheets, caregiver support resources, and information about how to work with our own Public and Payer Policy team.  So meet us in Arizona to get the latest on the impact of timely referrals on transplant outcomes and to chat with our team about our work removing financial barriers to transplant.

Find the conference agenda and register here: https://www.optumhealtheducation.com/txpcourse2018/

April 2018 Conference Updates

Posted April 5th, 2018 by Be The Match and filed in Payer Policy
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Executive Recap: AHIP Health Policy Conference in Washington D.C. March 6-8

This year’s National Health Policy Conference, held in Washington D.C. by America’s Health Insurance Plans, was an event for the ages!  The conference featured speakers and panelists well-known and influential in the health industry, including the HHS Secretary Alex Azar, FDA commissioner Scott Gottlieb, former CMS Director and IHI President Don Berwick, and many others.  Our team sent several staff who obtained insights as to what the various stakeholders are implementing when it comes to the federal and state health policy, internal operational/policy changes, and payer trends and initiatives to provide value based care.  Below is a summary of key points or trends that will impact access to cellular therapies for your consideration:

  • Value Based Insurance Design (VBID) holds promise for payers to provide true value by eliminating out of pocket costs for high value services. For example, CVS removed co-pays on both generic and brand name drugs.  This helped drive utilization to high value care.
  • Kenneth Burdick, CEO of Wellcare Health Plans, Inc. stated that 80-90% of prior authorizations will be removed from the company’s processes resulting in a better experience for their members.
  • CMS actuaries said high deductible health plans have helped control costs, so employers will continue to expand their use now and into the future.
  • Kavita Patel, Brookings Institution fellow and Johns Hopkins internist, stated that many oncology providers do not know the cost of pharmaceutical drugs for their patients, yet medication adherence and thus outcomes are driven by affordability of drugs according to a recent study in JAMA.
  • Technology is critical in the transition to value-based care, and as the amount of data payers have on their customers increases, opportunities for sharing information with providers will allow for shift to value-based payment arrangements.
  • Drug pricing affordability is an issue and patients need to be included in these conversations and be allowed transparency in pricing and benefits.
  • Social determinants of health framework is here to stay and payers are expected to navigate patients to resources. The National Marrow Donor Program (NMDP)/Be The Match ® has a variety of support programs to help you provide access to transplant and remove social barriers for your members.