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Considerations Related to the Coverage of Immuno-Oncology Therapies
During this one-on-one interview, a part of the Oncology Stakeholders Summit, Spring 2015 series, Michael Kolodziej, MD, discusses payer considerations regarding coverage for new cancer treatments such as immuno-oncology therapies.
Dr Kolodziej, national medical director of oncology strategy for Aetna, remarks that the PD-1 agents, including the FDA-approved checkpoint inhibitors pembrolizumab and nivolumab, have generated a great deal of excitement in the oncology community. These drugs are related in terms of their mechanisms of action, and Dr Kolodziej describes the potential opportunity for oral oncolytics to be managed by class effect. Rather than payers deciding whether or not certain drugs will be treated as a class, it is likely that companies or physician groups that develop treatment pathways will recommend a limited number of agents, taking into account safety and efficacy data and drug cost.
Payers’ coverage decisions are currently reflective of FDA approvals and recommendations from the National Comprehensive Cancer Network (NCCN), notes Dr Kolodziej. “Payers tend to respect, at least initially, the FDA label and subsequently expert opinion like that offered by the NCCN. I would say that if a payer made a decision that was in conflict with NCCN, they’d be in a very difficult place to defend that decision.”
Real-World Data Support Luspatercept vs ESAs for Anemia in Lower-Risk MDS
June 5th 2025Patients with myelodysplastic syndrome (MDS) who received luspatercept showed greater hemoglobin gains and transfusion independence compared with erythropoiesis-stimulating agents (ESAs) in a real-world analysis.
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At EHA 2025, Hematology Discussions Will Stretch Across Lifespans and Locations
June 5th 2025The 2025 European Hematology Association (EHA) Congress, convening virtually and in Milan, Italy, from June 12 to June 15, 2025, will feature a revamped program structure for the meeting’s 30th anniversary while maintaining ample opportunities to network, debate, and absorb practice-changing findings in hematology and oncology.
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Laundromats as a New Frontier in Community Health, Medicaid Outreach
May 29th 2025Lindsey Leininger, PhD, and Allister Chang, MPA, highlight the potential of laundromats as accessible, community-based settings to support Medicaid outreach, foster trust, and connect families with essential health and social services.
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Use of Voluntary Alignment in the Next Generation ACO Model
June 5th 2025Use of voluntary alignment attribution by Next Generation Accountable Care Organization (ACO) participants was limited. The authors highlight the reasons and describe organizational use cases via a mixed-methods approach.
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