Insurers pay for extra services that oncologists deliver in the hope that the investment will save them money down the road. That’s the idea, anyway. In practice, payers and providers in general see the concept as another example of how vexing payment reform for cancer care is turning out to be.
One of the federal government’s first physician-led specialty care models, the Oncology Care Model attracted many more practices than the Innovation Center originally envisioned, suggesting that oncologists liked the government’s offer. So will the OCM become the standard way to pay for cancer care in the future?
Approval of Merck’s checkpoint inhibitor is further evidence that cancer treatment decisions are increasingly dependent on the PD-L1 biomarker and other molecular-level differences in tumor cells. But testing for PD-L1 is tricky, and variations in the concentration of PD-L1 cells in different regions of the sample can produce different test results.
Insurers point to what they believe to be a paucity of solid evidence that the bevy of tests are useful for making treatment decisions. Also, if they wait a few years, then it’s Medicare’s problem. Meanwhile, men with prostate cancer must pay about $3,000 out of pocket for genetic tests.
To screen, or not to screen? For years, the question was rhetorical. Doctors screened, and health insurers anted up. The public still likes cancer screening, but some critics say that many tests have yet to show lifesaving benefit. The debate can get heated, as the mammography wars proved.
Screening advocates fear that skeptics are muddying the water, helping people rationalize skipping mammograms and other recommended tests and thus putting lives at risk. But screening boosters can take comfort in one thing that’s firmly on their side in the public debate: emotion.
RWE is a relatively new kid on the block. How exactly it will fit into the complicated world of cancer drug testing, approval, regulation, and marketing is uncertain. The randomized clinical trial has been the gold standard in oncology research for decades and will remain so for the foreseeable future.
Some are using the word “cure” for chimeric antigen receptor T cells. The modular nature of CAR T cells could provide novel strategies to combat resistance and convert more initial complete responses into lasting complete responses. Problems include: cytokine release syndrome, resistance, and finding ways to produce them more efficiently.