Drug Benefit Reform and Cancer Care

Conference Correspondent

During the December 2 session of the Association for Value-Based Cancer Care (AVBCC) 10th Annual Summit, expert panelists discussed drug benefit reforms and the movement of these reforms through Congress. Jayson Slotnik, JD, MPH, Managing Partner of Health Policy Strategies, moderated this discussion on benefits redesign and the intended and unintended consequences of the recommended provisions.

Jaime Barnes, SM, BA, Vice President of Value, Policy, Advocacy, and MS Commercial at TG Therapeutics, Inc, led the discussion by giving an overview on Medicare Part D proposals, including S 2543, HR 3, and S 3129 / HR 19. The major provisions include redesign, inflation penalty, and price negotiations.

Anna Kaltenboeck, MA, Senior Health Economist and Program Director at Memorial Sloan Kettering Cancer Center, said that these proposals are incomplete. Ms Kaltenboeck believes that the proposals are lacking in what happens with risk corridor payments, and the incentives in the reinsurance phase are not being addressed, even as we talk about shifting costs to health plans.

Douglas Hoey, RPh, MBA, Chief Executive Officer of the National Community Pharmacists Association, said that pharmacy direct and indirect remunerations (DIRs) have lowered prices artificially at a small amount, and we are seeing the same thing in the rebate reform. Patients who are using the benefit are not going to see the lower prices, and risk is going to continue to shift onto the government by forcing patients to the catastrophic phase faster.

Ted Okon, MBA, Executive Director at the Community Oncology Alliance, stated that the proposals do not look at the big problems. Mr Okon says we will not have real relief until rebates and the DIR system are reviewed.

Although manufacturers support many Part D patients through copay foundations, there is still a huge unmet need, according to Drew Saelens, MBA, Director of Government Affairs and Advocacy at Dendreon. Mr Saelens said that many manufacturers would fill more of the coverage gap if they felt they could do so without negative consequences.

Panelists touched on additional topics, including Medicare Part B, the ASP model, and the Most Favored Nation provision.

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