The Catalyst

Medicare Monday: Part B and biosmilars, part 2

Posted by Kelsey Lang on November 30, 2015 at 11:00 AM

Earlier this month, Medicare Monday covered the Center for Medicare & Medicaid Services (CMS) final rule on reimbursement for biosimilars and the implications of using a single billing code to reimburse biosimilars that share the same reference products on pharmacovigilance efforts. 

CMS’ policy will also change the payment rate for biosimilars under Medicare Part B and, in doing so, it could create barriers to physician and patient choice in accessing clinically appropriate treatment options.

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Topics: FDA, biologics, CMS, Medicare Monday, biosimilars

5 ways your insurer may prevent you from getting your medicine

Posted by Allyson Funk on November 30, 2015 at 6:00 AM

We’ve talked about the 5 things to consider when choosing your health coverage and the 5 questions to ask about your prescription medicine coverage, but it is also important to know the barriers insurance may still impose to accessing the medicines you need. Knowing these ahead of time can help you ask the right questions and look for coverage that works best for you.

Here are 5 ways your insurer may prevent you from getting your medicine:

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Topics: Access, out of pocket costs, step therapy, prior authorization, Access Better Coverage, ABCs of Coverage

ICYMI: Physicians want better information sharing with biopharmaceutical companies

Posted by Mit Spears on November 23, 2015 at 3:00 PM

The issue and debate around communications with health care professionals is at its very essence, a conversation about ensuring physicians have the best possible data to effectively treat patients. In an op-ed published in Morning Consult, Dr. R. Doyle Stulting, co-founder of the Stulting Research Center and the Director of Corneal Disease & Research at Woolfson Eye Institute noted FDA’s outdated regulations in this space and how sharing the latest information, which can improve patient outcomes, has become an increasingly burdensome venture [for manufacturers]. This is despite recent court rulings in the Caronia and Amarin cases explicitly allowing biopharmaceutical companies to provide truthful and non-misleading communications to health care professionals. Unfortunately, the FDA continues to muddy the waters with unclear guidance and inconsistent actions.

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Topics: FDA, Morning Consult

Bringing innovation to light during Lung Cancer Awareness Month

Posted by Hannah Mooney on November 23, 2015 at 12:00 PM

Lung Cancer Awareness Month is an opportunity to celebrate the stories of survivors, raise awareness about the leading cause of cancer death and continue the search for innovative new treatments and cures.

Lung cancer is the leading cancer killer for both men and women in the U.S. according to the American Lung Association, and in 2015 alone, approximately 27 percent of all cancer deaths will be from lung cancer. With lung cancer being the leader cancer killer in both men and women in the U.S., it is important to recognize the innovation happening to treat this deadly disease.

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Topics: Innovation, cancer, I'm Not Average, From Hope to Cures

Medicare Monday: The importance of shopping around for your Part D plan this Thanksgiving

Posted by Ashley Flint on November 23, 2015 at 9:00 AM

We’ve spent some time talking about the importance of shopping around during Part D open enrollment, which is currently underway until December 7th, 2015. Existing Part D plan coverage and individual health needs change from year to year so now is the time to review options and find the plan that works best for you.

Today, I want to share a personal story to demonstrate how important it is to shop around for a Part D plan.

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Topics: Part D, Medicare, open enrollment, Medicare Monday

Week in Review: The Latest from PhRMA

Posted by Priscilla VanderVeer on November 20, 2015 at 3:30 PM

Value of Medicine: Insurers continue to attack medicines and make it difficult for patients to access the drugs prescribed by their doctors. One patient shares his story about the difficulties trying to access the right medicine, at the right time.

340b Spotlight: A new study from The New England Journal of Medicine finds many non-profit hospitals are failing to meet the Affordable Care Act’s charity care requirements. Learn more about the impact on patients and why additional charity care requirements for hospitals that participate in the 340B program should be considered.

HHS Pharmaceutical Forum:  As the Department of Health and Human Services (HHS) hosts a forum on pharmaceutical innovation, access, affordability and better health today, here are six key facts we need to consider as we look at spending across the health care system.

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Topics: Week in Review

“Drug of the week”: one patient’s story

Posted by Pete Martinez on November 20, 2015 at 9:00 AM

Insurers’ attacks on medicines often fail to account for the value of a medicine brings to society, the health care system and individual patients. This is exactly what the nation’s health insurers did in a recent blog post about a class of innovative biologic drugs that has revolutionized care for patients with several autoimmune diseases, including those in rheumatology, dermatology and gastroenterology.

The following is just one voice on the value of these medicines, and what it means for patients to have access to the right medicine, at the right time.

For years my job has been to work with physicians, patients and other health advocates in state capitals across the South to promote public policies that will help folks who are struggling to get better coverage for the medicines they need to live healthier, more productive lives. I’ve been armed with facts and figures and good policy arguments and I know how to talk to lawmakers about why it is critical for patients to get the right treatments at the right time.

Then, four years ago, I learned more than I ever thought I would.

I, a relatively young person with no real history of health problems, was now a patient. 

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Topics: Value

340B Spotlight: New study raises questions about whether non-profit hospitals are meeting charity care requirements in Affordable Care Act

Posted by Karyn Schwartz on November 19, 2015 at 12:00 PM

New data published in The New England Journal of Medicine shows that many non-profit hospitals are not meeting charity care requirements in the Affordable Care Act. These requirements were intended to help address concerns from critics who questioned whether non-profit hospitals were providing sufficient benefits to justify their tax-exempt status, which was valued at $24.6 billion in 2011. Past analysis of 340B hospitals, which must be non-profit, found that about one-quarter provide charity care that represents less than one percent of their total patient costs. Additionally, about two-thirds of 340B hospitals provided less charity care than the average for all hospitals—including for-profit hospitals. This new study suggests that one reason for the low rates of charity care at many 340B hospitals is that in 2012 only 44 percent of non-profit hospitals regularly notified patients that they might be eligible for free or reduced price care before the hospital started debt collection.

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Topics: ACA, 340B, 340B Spotlight

6 things to know before the HHS forum

Posted by Robert Zirkelbach on November 19, 2015 at 9:00 AM

Tomorrow, the Department of Health and Human Services (HHS) will host a forum on pharmaceutical innovation, access, affordability and better health. We welcome the opportunity to discuss how we can ensure patients have access to the care and treatments they need without unnecessary barriers. And while discussions about cost are important, we need to look at spending across the health care system to find solutions that ensure access to high quality, patient-centered care and continue to encourage development of innovative, life-changing medicines.

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Topics: Access, Value, drug cost, Medicare, Payment and Delivery Reform, cost

PhRMA Foundation celebrates 50 years launching scientific careers

Posted by Eileen Cannon on November 18, 2015 at 2:50 PM

This November, we are pleased to be celebrating the Pharmaceutical Research and Manufacturers of America (PhRMA) Foundation’s 50th anniversary, commemorating five decades of jumpstarting the careers of more than 2,200 young scientists through $80 million in grant and fellowship awards.

Following a record-breaking year in 2015 of $3.6 million in new grants and fellowships to 43 young scientists, the Foundation is set to award $3.5 million in 2016 to 43 additional researchers.

Awards from the Foundation come at a critical point in young scientists’ careers, when they are beginning to establish themselves in their respective fields. Grant and fellowship funds are often used to establish labs, conduct experiments and explore novel disease targets.

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Topics: PhRMA, PhRMA Foundation

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