Developing a value framework for cancer drugs can sound like an arcane exercise without much relevance to clinical care. Restate it as a question of how, and how much, to pay for cancer drugs, and you’ve got everyone’s attention. Current and potential value frameworks are the subject of a special issue of Value in Health and ongoing examination by the Gant Precision Cancer Medicine Consortium at the University of Pennsylvania.
It seems self-evident: one way to address the epidemic of opioid deaths is to make prescription opioids harder to misuse. OxyContin, for example, is especially dangerous when it is crushed for ingestion, inhalation, or injection. In 2010, the FDA approved a reformulated, abuse-deterrent version of OxyContin that made the pill difficult to crush or dissolve. The new version immediately replaced the old one, marking a substantial reduction in the supply of abusable prescription pain relievers.
“Pay more for drugs that do more.” Although few would argue with the concept of paying for value, the mechanism for doing so has thus far eluded our multi-payer, market-based system. The Gant Precision Cancer Medicine Consortium at the University of Pennsylvania looked past US borders to learn about mechanisms in other countries, in its quest to recommend sustainable frameworks for valuing precision cancer drugs.
Biomarker-Defined Subsets of Common Diseases: Policy and Economic Implications of Orphan Drug Act Coverage
In PLOS Medicine, Aaron Kesselheim and colleagues, including LDI senior fellow Steven Joffe, investigate the policy and economic implications of the Orphan Drug Act of 1983, and examine the circumstances surrounding a drug’s discovery and development, secondary approvals, off label uses, subsequent revenues, and the reported monthly cost of biomarker-defined disease subsets. The Orphan Drug Act of 1983 was intended to incentivize the development of pharmaceutical products for rare diseases by providing manufacturers with the opportunity to earn grants, tax credits, free waivers,...
Medicare Part D beneficiaries can face as much as 33% coinsurance for some drugs listed in a “specialty tier,” which can result in thousands of dollars in out-of-pocket costs. The concern, of course, is that this level of cost-sharing creates a barrier that may put patients at risk for poor outcomes because they cannot afford the drugs they need.
A few weeks ago, I was chatting with another physician in the emergency department after finishing my shift. He had thrown a birthday party for his nine-year-old son Jake, who had recently recovered from a sports-related ankle fracture. “During the party, a parent pulled me aside and said he had recently injured his shoulder doing yard work,” my colleague said. “I assumed he wanted me to examine his shoulder or give him advice – but instead he explained that he didn’t have time to see his physician, and he asked whether we had any Vicodin left over from Jake’s surgery.
[cross-posted from the Health Cents blog on philly.com]
Prescribers are drawing a lot of attention as a key target of initiatives to combat the opioid crisis. This week, the US Surgeon General, Vivek Murthy, took the unprecedented step of sending 2.3 million clinicians a letter calling for a national movement to turn the tide on the opioid crisis.
[reposted from the CHERISH blog]
Impact of Medicare Advantage Prescription Drug Plan Star Ratings on Enrollment Before and After Implementation of Quality-Related Bonus Payments in 2012
In PLOS ONE, LDI Senior Fellows Pengxiang Li and Jalpa Doshi examine the impact of the Medicare Advantage Presciption Drug Plan star ratings before and after 2012, when they became tied to bonus payments. Does an increase in a plan’s star rating have a direct impact on concurrent year plan enrollment? What’s the indirect impact (via bonus payments) of star ratings on subsequent year plan enrollment?