The 1-year gap after the end of the Oncology Care Model (OCM) means some practices have to make hard decisions regarding cost of care or the financial health of the practice, explained Lalan Wilfong, MD, vice president of Payer Relations & Practice Transformation at The US Oncology Network.
Practices have hard decisions to make with the 1-year gap between the end of the Oncology Care Model and the start of the Enhancing Oncology Model, including whether or not to stick with biosimilars or return to the better reimbursement of brand drugs, explained Lalan Wilfong, MD, vice president of Payer Relations & Practice Transformation at The US Oncology Network.
Transcript
Biosimilars helped drive savings in the Oncology Care Model. With a gap in CMS oncology models, are there concerns that utilization of biosimilars may erode?
With the gap [between the end of] the Oncology Care Model [and start of the Enhancing Oncology Model (EOM)], practices have to think about their financial health. With the Oncology Care Model, we focused on things that were more cost-effective and made changes like the switch to biosimilars where we were able to generate significant savings because the cost of care was much lower than the brand drugs. However, in a fee-for-service world, as a practice, you have better reimbursement typically with the brand drugs than you do with biosimilars.
So, practices have to make hard decisions sometimes, you know? What we want to do to lower costs of care vs the financial health of the practice. The gap highlights that. And practices are having to make significant decisions about, “Do we stick with our biosimilar strategy? Do we need to switch back, because we're now not financially incentivized as much to use the lower-cost drugs?”
So that is an area of concern that I have, that practices will go back to things they did before that they need to maintain the financial health of their practice. Now, it is good that the EOM is starting. It's hard to switch drugs back and forth all the time. So, it is good that EOM is starting, so we still have an incentive out there, but the gap is challenging.
Persistence Pays Off With Zanubrutinib: A Challenging CLL Case With a Prior BTK Inhibitor Failure
May 10th 2024The case of a 77-year-old woman with a long chronic lymphocytic leukemia (CLL) history illustrates the novel use of zanubrutinib as a potential option for some patients who have failed first-generation Bruton tyrosine kinase (BTK) inhibitors and venetoclax.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen
Margin Status Likely Not a Factor in STS Recurrence
May 10th 2024The optimal negative margin required following surgical resection and perioperative radiotherapy for extremity soft tissue sarcoma (STS) remains up for debate, with investigators of a new study using Union for International Cancer Control classification to define resection margin.
Read More
A Focus on Women: AUA Best Posters Highlight Female Athletes, Prenatal Care, and Women in Urology
May 9th 2024Three posters from the American Urological Association (AUA) 2024 Annual Meeting focused on urinary incontinence in female athletes, prenatal care for fetuses with spina bifida in California, and the experiences of women residents at the Brady Urological Institute.
Read More