While the Oncology Care Model (OCM) is likely not a sustainable mode for oncology care, it will probably inform what payment structure comes next.Read more
Kolodziej, who was on a panel following Verma’s speech, said over time doctors will be paid less.
“Let’s just be clear, because I’m going to tell you right now, keeping doctors whole in this model is just not going to happen,” he said.
He said the inflation index used to calculate that fee will not keep pace with medical-cost inflation or the rising costs of new drugs. That means doctors will soon be making less than they otherwise would have, he said.Read more
Lindsay Bealor Greenleaf, director at health-care consulting firm ADVI, said it’s clear Express Scripts is responding to pressure from policymakers.
“This announcement aligns with the direction things are headed in Washington — of policymakers rethinking the role played by rebates,” Greenleaf said. “This is a proactive step to get prepared for a new environment that will change up their business.”Read more
A label change to allow for more outpatient use would allow for a “defined path which has fewer hurdles than the reimbursement path in the inpatient setting,” ADVI founder and CEO Marc Samuels said in an interview with the Pink Sheet.Read more