CMS has proposed a rule to make it easier for private insurers to enter value-based payment arrangements with drugmakers—arrangements tied clinical outcomes. The goal: Expand access to costly new therapies, such as gene therapy. It will also apply to Medicaid programs. The change “shifts us away from our typical negotiations around drug pricing, which are usually volume-based…to negotiations around outcomes, and increases competition for manufacturers to develop drugs that are not only cost-effective but have a definitive clinical outcome,” CMS Administrator Seema Verma said in press call last Wednesday, Modern Healthcare reports. (Modern Healthcare)
Computer scientists working with pathologists have trained an artificial intelligence tool to determine which patients with lung cancer are at higher risk of having their cancer return after treatment. It’s part of Cancer Research UK’s landmark TRACERx study. The AI tool differentiated between immune cells and cancer cells, enabling researchers to build a detailed picture of how lung cancers evolve in response to the immune system in individual patients. Ultimately, this could speed up how doctors can predict which patients are more likely to see their lung cancer return, so they can be closely monitored with tailored treatment plans. (Nature Medicine; Cancer Research UK announcement)
Evidence & Innovation
Three people with the inherited blood diseases sickle cell and beta thalassemia are still doing well, months after receiving genetically modified stem cells. They no longer need regular blood transfusions, and their worst symptoms have disappeared. They are the first patients in pioneering studies of a therapy based on the gene editing technology known as CRISPR. “The clinical manifestation of the disease is different, but we see consistent outcomes across both diseases,” says Bastiano Sanna, Vertex’s head of cell and genetic therapies. (BioPharma Dive)
If we are to incorporate genomic data in the EHR, providers need to tackle the issues of patient access, privacy and protection, according to a report from the American College of Medical Genetics and Genomics. “As genomic data become more complex, so too must the EHR evolve to provide optimal care for patients, maximizing benefits while minimizing harm,” the authors wrote. However it happens, “incorporation of a variety of genomic data into an individual’s EHR will ultimately be necessary for the delivery of precision medicine.” (HealthIT Analytics; report)
In human challenge trials, researchers inject healthy volunteers with an experimental vaccine and then expose them to the pathogen. If the vaccine prevents volunteers from getting sick, the study can accelerate development of a promising vaccine—in this case, for COVID-19. Researchers and health leaders are grappling with the ethical and scientific implications. Such trials are “on the table” for discussion, says Dr. Francis Collins, director of the National Institutes of Health. “If this went all wrong, and some healthy volunteer died as a result, that would be impossible to forgive ourselves.”(Washington Post)
Medicare Advantage and ACOs could drive the much-needed value-based payment reform in Medicare, but it needs better-aligned incentives and improved quality assessment, according to MedPAC’s June report to Congress. It suggests Medicare could do more to encourage global payments, which would provide more predictable revenue. In a call with reporters, MedPAC Executive Director Jim Matthews said “progress toward value-based payment throughout the Medicare program needs to accelerate and more of the program needs to be detached from straight fee-for-service payment.” (Healthcare Dive; report)
In Case You Missed It!
GTMRx workgroup update
The Best Practices and Innovative Solutions Subgroup of the GTMRx Practice and Care Delivery Transformation Workgroup has recruited several new members: David Zgarrick (Northeastern University), Lara C. Kerwin (BJC Medical Group and Accountable Care Organization), S. Michael Ross (Cureatr; Connected Health Strategies), Sarah McBane (Susan & Henry Samueli College of Health Sciences), Nathan A. Painter (UC San Diego Skaggs School of Pharmacy and Pharmaceutical Science), Katrina K. Harper (Center for Pharmacy Practice Excellence), Lindsey Hall (Genoa Healthcare), Erica L. Dobson (Accountable Health Partners).
Close to 800 people registered for our recent webinars. Did you miss them?
Pharmacogenomics: What You Need to Know During COVID-19 and Lessons Learned from Implementation in Team-based Care
It makes sense that evaluation of a patient’s genotype can support the clinical decision-making process, improving patient outcomes. So, why are advances made at the bench not reaching the bedside? What are the barriers we need to overcome? Further, how do we incorporate PGx into team-based care, and how can PGx aid in treatment decisions for COVID-19 patients? This webinar will explore PGx with overviews from two recently published articles.
The COVID-19 global health care crisis has created a real opportunity to expand access to care through telehealth. How do we optimize patient outcomes and ensure appropriate use of medications virtually? Hear from a clinical pharmacist and a policy analyst as they discuss barriers to implementation and opportunities that the coronavirus pandemic offers to expand telehealth services. They will consider in what way these changes may impact care delivery.
Remarks from the GTMRx / Bipartisan Policy Center Feb 6 keynote address by Gregory Downing, D.O.,(page 10-13) “Get the Medications Right: Innovations in Team-Based Care,” in the latest edition of the Personalized Medicine Coalition’s Personalized Medicine in Brief. Read it here.
Hosted by the GTMRx Institute’s executive director and co-founder, Katherine H. Capps, Voices of Change features leaders who have knowledge, experience and ideas to solve this urgent need to get the medications right. The most recent episode features Orsula V. Knowlton, PharmD, MBA, president and chief marketing & new business development officer of Tabula Rasa HealthCare, Inc. Past guests include Anand Parekh, MD, chief medical advisor, Bipartisan Policy Center and GTMRx President Paul Grundy, MD, chief transformation officer, Innovaccer. Listen here.