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Blinatumomab Wins CMS Favor Following Reevaluation
An immunotherapy developed by Amgen and approved by the FDA for the treatment of acute lymhoblastic leukemia in December 2014 has now received coverage assurance from Medicare, following an initial rejection.
An immunotherapy developed by Amgen and approved by the FDA for the treatment of acute lymhoblastic leukemia in December 2014 has now received coverage assurance from Medicare, following an initial rejection of the expensive drug that costs $178,000 for a standard course.
Blinatumomab (Blincyto) was granted accelerated approval for treating Philadelphia chromosome—negative (Ph-) relapsed or refractory B-cell precursor acute lymphoblastic leukemia (ALL). Evidence submitted to the FDA showed that 32% of 185 adults with B-cell ALL had complete remission for more than 6 months following drug infusion.
This new approval from CMS is for the “add-on payments” made to hospitals for new technology whose costs are not yet reflected in the standard lump-sum amounts that hospitals receive for treating patients with a particular disease or disorder. New information submitted by Amgen convinced the decison-makers at CMS of the "value" that blinatumomab would render compared with exisiting treatments for B-cell ALL.
Read more at The New York Times.
Trump Administration’s Message to Supreme Court Puts New Wrinkle in Braidwood Case
February 21st 2025The Trump administration argues that HHS Secretary Robert F. Kennedy Jr can overrule the US Preventive Services Task Force to determine the preventive services covered under the Affordable Care Act.
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Varied Access: The Pharmacogenetic Testing Coverage Divide
February 18th 2025On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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Insurance Payer Is Associated With Length of Stay After Traumatic Brain Injury
February 21st 2025Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.
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