The Daily Rise: Tuesday, February 23

Blockbuster Year for Patients

Raheel Farooq of Business Finance News expects Roche and Merck “to launch their blockbusters in 2016.” It’s exciting news for patients — who could benefit from more than a half-dozen major drugs being brought to market to combat HIV, hepatitis, and cancer. Among the most promising drug developments highlighted in the report:

  • Ocrelizumab by Roche: Ocrelizumab is indicated for the treatment of relapsing/remitting, as well as primary progressive multiple sclerosis. The drug is undergoing phase 3 trial, and belongs to the anti-CD20 mAb (biologic) class.
  • Atezolizumab by Roche: Roche has plans to move forward with its PD-L1 inhibitor, atezolizumab, in advanced bladder cancer. The trials showed encouraging positive results in a phase II trial.
  • Venetoclax, AbbVie/Roche: The drug just received its third breakthrough therapy designation from the FDA. Both companies are working to receive approval for the drug for use in patients suffering from chronic lymphocytic leukemia (CLL).

Patient Education: Billing 101

The Bismarck Tribunes’ Jennifer Johnson sheds some light on why charges for medical treatments are so confusing for new patients.

“Billing for health services is complex, it’s hard to understand,” Dan Trustem, vice president of revenue services for Fargo’s Essentia Health, told the Times. “For a lot of people, it’s their first time (being confronted with an outstanding bill or big procedure) and they get confused.”

This piece is a great reminder for experienced patient advocates that we have an obligation to educate other patients, especially first-time patients, on the common billing pitfalls. Save this piece in your files for the next time you need to walk someone through the basics of Billing 101.

#FailFirstFeb

This month, we’re joining the millions of patients fighting the devastating policies of insurance companies that enforce “fail first” policies.

Join us in sharing Dr. Jeffrey Bennett’s outstanding piece at Reboot Illinois, which effectively dismantles step therapy.

“I have seen many patients harmed when their medication was discontinued because their insurance company, or other payer, stopped paying. This can result in hospitalizations, homelessness and much suffering for both patients and their families.”

“We need to make sure that clinical judgment is used whenever medications are prescribed or changed. While step therapy can save us money in some cases, medical expertise regarding the best interest of the patient should be a higher priority in treatment decisions than insurance formularies.”

Partnership for Patients Campaign

Tom Evans, president and CEO of the Iowa Healthcare Collaborative, shares the positive results from Iowa’s participation in the Centers for Medicare & Medicaid Services’ Partnership for Patients campaign.

“In this environment of trust and collaboration, these hospitals wanted to — and still strive to — report what went wrong so they can improve and then share their findings with others,” Evans writes in an opinion piece at the Des Moines Register.

Not surprisingly, this approach helped patients. In total, the 128 participating hospitals reported impressive results, including:

  • Adverse drug events decreased 99.9 percent.
  • Pressure ulcers decreased 89.4 percent.
  • Central line-associated infections decreased 34.7 percent.
  • Surgical site infections decreased 19.5 percent.
  • Falls decreased 10.4 percent.

This is the right approach and more health care providers should follow this model of identifying errors in order to better serve patients. “Because of these improvements, Iowans have seen an avoidance of 3,310 adverse events, 15,603 fewer days in the hospital, and more than $50 million in cost savings.”

Are There Cracks In ICER’s Latest Report?

Finally, be sure to check out our latest post on the flaws with the Institute for Clinical and Economic Review’s creation of a “value framework.” While ICER is crunching its numbers, we hope it will avoid stiff preconditions and rigid assumptions that impose a simplistic conclusion about the need to drain dollars out of the current system and the most decisive way to do it.

The fact is, the economics of access to medical therapies is no less dynamic than the science of developing them. To borrow the parlance of the think tank: We’re dealing with a dynamic issue here that is constantly and forever changing. For all its smarts, we fear that ICER is starting from the classic static analysis and imposing a fix – like one would repair a broken window.

It is especially disquieting that ICER is arranging a value framework for multiple myeloma, not only for the reasons mentioned above, but because this disease strikes particularly close to our hearts and that of our friends.

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