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Practice Transformation

Effective Jan. 1, BCBS of Tennessee will no longer reimburse providers for some specialty infusion drugs. Instead, it requires providers to get the drugs through a specialty pharmacy in BCBS’ preferred network. According to BCBS, the policy aims to slow the growing cost of specialty drugs. However, some providers say it could cause them to end their infusion services and force patients to find other sites. They say they were blindsided and never consulted as to how the change could affect patient care. For now, the change only applies to members in 100 self-funded employer groups. (Becker’s Hospital ReviewChattanooga Times Free Press)
More than 250,000 participants have been enrolled in Geisinger Health System’s MyCode precision medicine initiative, which launched in 2007. Today, DNA sequences and health data are currently available for 145,000 of those participants. MyCode, the largest health care system-based precision medicine program, combines clinical data from electronic health records with genetic sequencing to enable the prevention or detection of early-onset cancer and cardiovascular events for patients who are at high risk for these inherited diseases. (Health Data Management)

Evidence & Innovation

One biotech venture capital firm is taking a different approach and offering grants for cancer research. Last month, VC firm MPM Capital and the American Association for Cancer Research announced the first two grants from the AACR-MPM Transformative Cancer Research Grants Program. Each project will receive $400,000 over a two-year period. Under the program, proposed research must represent a highly innovative approach to a major problem or challenge in cancer research that may not be funded through conventional channels. (STATannouncement)
To gain approval for a new drug or a new use of an existing one, drugmakers are shifting away from conducting traditional clinical trials and instead determining the efficiency of a drug by analyzing data sets from electronic records, The Wall Street Journal reports. Companies are mining hospital and doctor files for cases where patients already took a drug in routine medical care. Pfizer, Johnson & Johnson and Amgen, among others, have submitted data-mining analyses to the FDA, which has approved new uses for breast cancer, bladder cancer and leukemia drugs in part based on the data. (WSJ)

Policy Solutions

The CMS Innovation Center has awarded 17 states nearly $200 million over the next seven years to combat opioid misuse among expectant mothers and improve care for children affected by the crisis. Of those, 10 states will receive funding under the Maternal Opioid Misuse (MOM) Model. MOM focuses on the fragmentation in the care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder. Seven states will share $126 million over the next seven years to launch the Integrated Care for Kids program. (Modern HealthcareCMS)
CMS updated its drug-spending dashboards last month to include pricing data from 2018 in an effort to increase pricing transparency and lower drug costs. The dashboards focus on average spending per dosage for prescription drugs paid for by Medicare Parts B and D as well as Medicaid. They also track the change in average spending per dosage over time, display the name of each drug’s manufacturer and show information on drug uses and clinical indications. The update is the most comprehensive to date, according to CMS. (CMSBecker’s Hospital Review)
February 6, 2020 | 8:30-10:30 am
The Bipartisan Policy Center and the GTMRx Institute will co-host, “Get the Medications Right: Innovations in Team-Based Care.” This event will feature keynote presentations and a panel discussion with leaders—including Katherine Herring Capps, Carolyn Clancy, M.D., Susan Dentzer, M.P.H.,Michael Evans, RPh, Elizabeth Fowler, J.D., Ph.D., Anand Parekh, M.D., and Dan Rehrauer, Pharm.D.—who have been at the forefront of advancing the appropriate and personalized use of medication and gene therapies. As an organization that actively fosters bipartisanship by combining the best ideas from both parties to promote health, security and opportunity for all Americans and that prioritizes “getting things done” above all else, the Bipartisan Policy Center offers an ideal venue for this important event.
Seating is limited to 130, so please be sure to register to attend. There will also be a live-stream of the event. You can find more information here.
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