This Week in Managed Care: December 26, 2015

Hello, I’m Justin Gallagher, associate publisher of The American Journal of Managed Care. Welcome to This Week in Managed Care, from the Managed Markets News Network.

This week, we bring you highlights from the American Society of Hematology’s recent meeting in Orlando, Florida.

Newly Approved Drugs

New therapies received plenty of attention, since the FDA was quite busy in the weeks leading up to ASH.

At a special session with the FDA, reviewers who handled approvals for 3 new drugs to treat multiple myeloma discussed the evidence for daratumumab, ixazomib, and elotuzumab. Then, physicians who have used the drugs in clinical practice shared their thoughts on how to sequence these new therapies and use them in combination with existing therapies, such as lenalidomide and dexamethasone, or bortezomib.

One expert at the session said there are now 22 potential treatment strategies for multiple myeloma within the NCCN guidelines.

Blinatumomab

At a separate session on newly approved treatments, a presentation on blinatumomab, which has been approved for acute lymphoblastic leukemia, showed that while administering the drug presents some challenges, it’s also meeting an unmet need for certain patients.

Rivaroxaban

Scientists from the University of Utah presented findings that show that rivaroxaban could be an alternative to low-molecular weight heparin to treat venous thromboembolism in cancer patients. Among 92 cancer patients who received rivaroxaban, 10 had a major bleeds after an average period of 4 months, although other drugs may have contributed to these events. Only 4 patients had recurrent VTE while taking rivaroxaban, leading researchers to conclude that the therapy may be a safe and acceptable alternative to heparin in cancer patients.

Pay-for-Performance

Policy sessions at ASH encouraged attendees to think about the increased role of pay-for-performance and how to include the voice of patients in measuring success.

Dr. Helen Burstin, the chief scientific officer at the National Quality Forum, explained that CMS wants 50 percent of reimbursement to be tied to value-based payment models by 2018, while Dr. Andrew Ryan of the University of Michigan wondered what the current reporting systems will mean for hematologists.

Outcomes

Patient reported outcomes will continue to play a bigger role, and Dr. David Cella of Northwestern University said this will make a difference in a field where measuring tumor response has been the norm. In the future, he said, creating measurements for things like fatigue and ability to function will carry more weight, in addition to overall survival.

Choosing Wisely

ASH takes part in the Choosing Wisely campaign, an initiative of the ABIM Foundation to eliminate unnecessary tests and procedures that can cause patient harm and create added costs.

For 2015, ASH researched recommendations from other professional societies for items of interest to hematologists. The ASH Choosing Wisely committee highlighted the following:

• Don’t image for suspected pulmonary embolism without moderate or high pretest probability of P-E.
• Don’t routinely order thrombophilia testing for patients receiving routine infertility evaluation.
• Don’t perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability.
• Don’t transfuse red blood cells for iron deficiency without hemodynamic instability.
• Avoid using positron emission tomography scanning during routine follow-up to check for cancer recurrence in patients without symptoms who have finished treatment, unless there is high-level evidence imaging will change the outcome.

You can read more about ASH 2015 in our upcoming special issue of Evidence-Based Oncology.

For everyone at the Managed Markets News Network, I’m Justin Gallagher. Thanks for joining us.