June 2019

AJMC®TV interviews let you catch up on what’s new and important about changes in healthcare, with insights from key decision makers—from the clinician, to the health plan leader, to the regulator. When every minute in your day matters, AJMC®TV interviews keep you informed. Access the video clips at ajmc.com/interviews.

Coverage from The American Journal of Managed Care's® Institue for Value-Based Medicine® meetings.

Conference coverage from the annual meeting's of the Florida Society of Clinical Oncology's annual meeting and ISPOR.

Oral oncolytics, or oral chemotherapies, have significantly impacted the treatment of cancer. They enable patients to conveniently manage treatment in their homes. Despite the rapid growth, therapeutic advances, novel mechanisms of actions, and improved outcomes associated with these agents, the dispensing process remains inadequate. As a result of rising drug costs and healthcare expenditures, payers have forced a “medically disintegrated” model of dispensing, limiting patients and practices to fill prescriptions through external mail-order pharmacies.

When asked why drug prices are so high, manufacturers offer some version of the same answer: the cost of research and development. Although there is debate over how much it actually costs to bring new therapies to market, a 2016 study by Tufts University put the price tag at $2.56 billion (in 2013 dollars), and researchers found costs were rising 8.5% a year. Failure rates of drugs also contribute to their high prices. A 2018 paper coauthored by Andrew Lo, PhD, of the Massachusetts Institute of Technology found that the probability of success in clinical trials was 13.8%, but the success rate within just oncology was 3.4%.

The availability of biosimilar products may improve access to healthcare by increasing the number of therapeutic options available at potentially lower costs. As of April 2019, 18 such biological products had been approved by the FDA, including 4 biosimilars for trastuzumab, 3 each for infliximab and adalimumab, 2 each for pegfilgrastim and filgrastim, and 1 each for rituximab, epoetin alfa, bevacizumab, and etanercept. The pace of approvals has accelerated, from the first indication for a filgrastim biosimilar in 2015 to 3 approvals in 2016, 5 in 2017, and 9 through early 2019, 7 of which were announced in the 2018 calendar year.

There is an epidemic failure within the game to understand what is really happening. ––Peter Brand (Jonah Hill), Moneyball, 2011.

A year ago, the National Comprehensive Cancer Network (NCCN) added the word “accessible” to its mission statement, stating that the group is “dedicated to improving and facilitating quality, effective, efficient, and accessible cancer care so that patients can live better lives.”

The US healthcare system remains one of the most inefficient healthcare systems in the world. The Bloomberg Health-Care Efficiency Index ranked the United States 54th among 56 countries in 2018, tied with Azerbaijan and only ahead of Bulgaria. This occurs even though the United States spends $10,244 per capita annually on healthcare, a figure representing 17% of the gross domestic product.

More and more, stakeholders across the healthcare system— providers, commercial payers, pharmaceutical companies, large employers, state Medicaid officials, and even state budget officers—are grappling with the fact that the old pay-as-you-go way of covering medicines, even cancer drugs, was not built for these revolutionary therapies. A group at MIT is developing new models, which use reinsurance and payments over time to fund these durable treatments.