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Some Practices Now Are Taking Two-Sided Risk in CMS’s OCM

July 1, 2019

As CMS’s Oncology Care Model (OCM) starts its third year this month, participants who spoke with AIS Health say it has been an overall positive experience. Developed by the CMS Center for Medicare & Medicaid Innovation (CMMI), the five-year voluntary pilot is aimed at providing better quality and more coordinated cancer care for Medicare fee-for-service beneficiaries, as well as other payers, while at a lower cost. So far, all participants have been in one-sided risk arrangements, but now, for the first time, some practices are participating in a two-sided risk model. A recent Avalere Health analysis of the OCM’s first year, though, shows that many providers would owe recoupments to CMS under either of the two available two-sided risk models.

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Study: Expensive Drugs Launched After OCM Baseline Period Are Hamstringing Providers

July 1, 2019

One criticism of CMS’s Oncology Care Model is that providers’ costs are compared with targeted costs that are based partly on their spending from 2012 to 2015, the OCM baseline period. When the actual costs come in below the targeted costs, that earns providers a performance-based payment. But with so many costly oncology therapies launching after the baseline period, this is making it hard for providers to gain a performance-based payment.

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Community Oncology Alliance Proposes Next-Generation OCM 2.0 Model

July 1, 2019

CMS’s Oncology Care Model (OCM) is about halfway through its five-year pilot, and one industry group recently put out its vision of what a next-generation version of the program should look like. Last month the Community Oncology Alliance (COA) unveiled its proposed OCM 2.0 to the Physician-Focused Payment Model Technical Advisory Committee (PTAC), which evaluates physician-focused payment models for HHS. The comment period closed July 1, and comments will be posted on the PTAC website about a week after the closure of the comment period.

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Plans Must Cover PrEP for Free After USPSTF Recommendation

July 1, 2019

A few recent actions, as well as one expected next year, are expected to help bring down rates of HIV infection. And while the efforts should make it easier for certain populations to gain access to preexposure prophylaxis (PrEP) that helps prevent them from acquiring HIV, some issues are likely to stand in the way of eliminating all infections.

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About Half of Payers Say They Will Prefer Herceptin Biosimilars

Payers covering nearly 50%of lives plan to prefer biosimilar Herceptin over all other HER2+ adjuvant Breast Cancer agents

July 1, 2019

When the FDA approved Amgen Inc. and Allergan plc’s Kanjinti (trastuzumab-anns) on June 13 (see brief, p. 8), it became the fifth biosimilar of cancer drug Herceptin (trastuzumab), from Genentech Inc., a member of the Roche Group, that the agency has approved, as well as the 20th biosimilar overall. With the Herceptin biosimilars expected to become available later this year, almost half of commercial payers responding to a Zitter Insights survey say they expect to prefer biosimilar Herceptin over other similar drugs for the adjuvant treatment of breast cancer.

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