An important issue, according to Dr Kolodziej, national medical director of oncology strategy at Aetna, is whether cost could potentially be a barrier for true breakthrough medications such as the PD-1s. During the second segment of a one-on-one interview conducted at the Oncology Stakeholders Summit, Spring 2015 series, he emphasizes the importance of biomarkers to help identify patients who will most benefit from the treatment. Like in hepatitis C, payers want to better understand who is the right patient to treat with high-cost breakthrough drugs and what is the right time to treat. Dr Kolodziej states that the goal with breakthrough therapies is to lower or reduce the barriers that patients face in receiving them.
Dr Feinberg, vice president and chief medical officer at Cardinal Health Specialty Solutions, agrees that although cost is a barrier for every agent, the PD-1 agents’ high efficacy and low toxicity override, to an extent, the cost barrier.
The new CMMI Oncology Care model concerns both Drs Kolodziej and Feinberg in that it does not adequately compensate for expenses incurred when appropriately using innovative products. If a physician prescribes PD-1 treatment, the total cost of care will be higher, and the oncology practice will be disadvantaged. If the CMMI Oncology Care model is based on an episode-of-care or bundled care, breakthrough therapeutics that raise the aggregate cost to the practice will not be preferred. Dr Kolodziej explains that it may take a couple of years to find that savings are not being generated, owing to the high cost of innovative agents, forcing CMMI to adjust the model.
Watch our related Peer Exchange, Oncology Stakeholders Summit, Spring 2015.
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.
Read More
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.
Read More
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.
Listen
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.
Read More
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.
Read More
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.
Read More
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.
Listen
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.
Read More
2 Commerce Drive
Cranbury, NJ 08512