The Daily Rise: Thursday, April 7

The War Against the War on Cancer

“A war on prices might make sense for rival pizza parlors or the local Best Buy,” our very own policy director Jonathan Wilcox writes in a piece for Morning Consult. “When it comes to sick people and their medicine, it’s nothing short of dangerous – or deadly.”

Wilcox explains that there are two competing forces in medicine.

While the White House has proposed a “Moonshot” to advance a cure for cancer, presidential candidates, policymakers, regulators and activists are lining up behind an agenda that would stifle medical innovation and scrub this launch before it ever gets off the ground. Specifically, they’re demanding so-called “value frameworks” – complicated medical and math formulas that rate new and existing therapeutics based on dollars and cents rather than medical effectiveness.

One such framework for a type of blood cancer is being rolled out on April 7 by the Boston-based Institute for Clinical and Economic Review. This development represents a direct threat to the very thing that patients need most – medical innovation.

Read the entire piece published at Morning Consult’s website.

Cancer Care: Cost Drivers

Don’t believe the headlines. The cost of treating patients with cancer has remained in line with the overall costs for Medicare and commercially insured populations over the past decade. That’s the finding of a new Milliman study commissioned by the Community Oncology Alliance.

“There has been a long-held belief in research and policy circles that cancer care costs in America have gone up disproportionately as compared to other health care costs,” said Dr. Debra Patt, a practicing oncologist at Texas Oncology, who participated in the study. “This study shows that this commonly held belief is not supported by the evidence.”

The numbers show that costs have remained comparable across various patient groups.

Cost Increases Among Medicare Patients

  • Total Population: 35.2% per patient per year
  • Actively Treated Cancer Population: 36.4% per patient per year
  • Non-Cancer Population: 34.8% per patient per year

Cost Increases Among Commercially Insured

  • Total Population: 62.9% per patient per year
  • Actively Treated Cancer Population: 62.5% per patient per year
  • Non-Cancer Population: 60.8% per patient per year

Legal Protections Against Harmful Insurance Practices

Aimed Alliance, a non-profit organization focused on improving innovation, is helping educate patients about their rights to fight back against harmful insurance practices.

“These practices serve to financially exclude patients with a pre-existing condition, create a blatant conflict of interest for the physician, take up valuable physician time trying to obtain approval for the treatments,” warns Stacey L. Worthy, Director of Public Policy at the Aimed Alliance, “and in the end, just serve to save company money.”

Among the most destructive insurance policies:

  • Fail first policies in which patients are required to fail on older, inferior treatment before getting the treatment their doctors prescribed;
  • Adverse tiering in which most, if not all, medications, including generics, used to treat a condition, such as HIV or Hep C, are placed on the highest cost-sharing tier in which up to 50% of costs are passed on to the patient;
  • Clinical pathways in which an insurer pays a practitioner to prescribe a cheaper medicine despite the patient’s needs;
  • Prior Authorization in which practitioners can spend up to 20 hours a week on the phone with insurers trying to obtain approval for treatment they’ve prescribed for their patients; and
  • Nonmedical switching in which insurers are forcing stable patients to switch to different cheaper medications without even informing the patients’ doctor.

FDA Approval

As part of our ongoing series alerting patients to new treatments, we share the news that the Food and Drug Administration has granted approval to the second biosimilar. The treatment will help patients with Crohn’s disease, ulcerative colitis, rheumatoid arthritis, psoriasis and arthritis of the spine.

“Biosimilars can provide access to important treatment options for patients who need them,” Dr. Janet Woodcock, director of FDA’s Center for Drug Evaluation and Research, said in a press announcement. “Patients and the health care community can be confident that biosimilar products are high quality and meet the agency’s rigorous scientific standards.”

The drug, Inflectra, is the result of innovation by Celltrion and Pfizer. It was developed as an alternative to Johnson & Johnson’s drug Remicade, originally licensed in 1998.

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