The Daily Rise: Wednesday, June 15

Insurers May Never Use Value Frameworks? Come Again?

Do you think you read that right?

We definitely did a double-take — but we heard it from Michael Kolodziej, MD, National Medical Director for Oncology Strategy at Aetna while watching an American Journal of Managed Care video.

It’s no secret we have some skeptisism about the design of value frameworks and their lack of patient perspective and input. It turns out Dr. Kolodziej has some of the same reservations we do.

He says two things are missing: 1) Real-world evidence and 2) The Patient Voice.

Now this could just be his way of buttering us all up for when he thinks they are out of their infancy … next year — but in the meantime we’ll be watching Aetna and others as they look at these frameworks. If everyone joined Dr. Kolodziej in this thought process, perhaps we could really start move the dial for patient access as innovation flourishes?

To hear Dr. Kolodziej’s full statement on the matter, visit the American Journal of Managed Care.

Nerd Alert: Your Drug Formulary

Lacie Glover at Nerd Wallet writes a great primer on understanding your drug formulary. Why would you need to understand your drug formulary?

If you’ve ever had to jump through hoops to get a prescription covered by your health insurance, you have some firsthand knowledge of drug formularies, Lacie writes.

If you’ve ever wondered how formularies are chosen, how they work, what is tiering and other buzz words like step therapy and prior authorization — then this is a must read for you. The days of patients sitting back and letting health care happen to them are long gone. Today you must be vigilent every step of the way and leave nothing to chance if you can help it. Fully understanding your insurance policy is a great place to start.

Voices of Value: Is It Possible to Thrive After Stage IV Lung Cancer?

This is part of our patient voice series. Today we feature Lisa Goldman, a stage IV lung cancer survivor living in California and thriving. We met Lisa last year at the World Conference on Lung Cancer in Denver and had the pleasure of meeting her through the Addario Lung Cancer Foundation.

Just a few weeks after my diagnosis, I learned my cancer had tested positive for a rearrangement of the ROS1 gene. Of course, the first thing I did was Google the crap out of the term “ROS1.” I didn’t understand most of what I read, but one thing did catch my attention and really hooked into my heart. It was fellow ROS1+ blogger Luna Okada’s February 11, 2014 blog featuring pictures of her in an indoor cycle class. I’d been teaching cycle classes just a few weeks prior, but that seemed a million miles away as I lay in bed reeling from chemo. It took a herculean effort just to walk around the block towing an O2 tank. And then I saw Luna cycling, smiling, looking strong and healthy. It would be hard to overstate the impact those pictures had on me. Suddenly, the impossible seemed possible. If she did it, then maybe I could, too. Sometimes a picture really is worth a thousand words. And, that’s what today’s blog is about.

Click here to see the pics and read on.

Advocacy Spotlight: Community Oncology Alliance

The Community Oncology Alliance (COA) is a non-profit organization dedicated to advocating for community oncology practices and, most importantly, the patients they serve. COA is the only organization dedicated solely to community oncology where close to 70% of Americans with cancer are treated.

The mission of COA is to ensure that cancer patients receive quality, affordable, and accessible cancer care in their own communities. More than 1.5 million people in the United States are diagnosed with cancer each year and deaths from the disease have been steadily declining due to earlier detection, diagnosis, and treatment.

Cancer treatment can be intense and span many years requiring regular physician visits for chemotherapy and checkups. Keeping patients close to their homes, families, and support networks lessens the burden of this devastating disease. With the majority of Americans battling cancer receiving treatment in the community setting, it is imperative that the vitality of the community cancer care delivery system be preserved.

For nearly 14 years COA has built a national grassroots network of community oncology practices to advocate for public policies that benefit patients. Individuals from all levels of the cancer care delivery team – oncologists, hematologists, pharmacists, mid-level providers, oncology nurses, patients and survivors – volunteer their time on a regular basis to lead COA and serve on its committees.

By offering innovative solutions to Congress and policymakers, empowering patients, and working closely with other healthcare stakeholders, COA is helping to shape a future where all Americans have access to quality, affordable cancer care.

Follow Community Oncology Alliance on Twitter.

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