The 800-Lb. Gorilla: Drug Costs Loom Large In Medicare Oncology Care Model
Drug costs make up 60% of the total cost of cancer care, participants in the Medicare Oncology Care Model have found. But efforts to manage spending under the demonstration have so far focused instead on areas that represent a smaller portion of overall costs, such as hospitalizations.
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CMS’ innovation center creates new division to test alternative payment models, including likely new approaches for accelerated approval drugs and multi-state outcomes-based payment arrangements for cell and gene therapy in Medicaid.
CMMI payment demonstrations are viewed as way of skirting statutory obstacles to experimenting with new approaches to reimbursement and could lead to significant drug pricing reforms if legislative efforts fail. However, HHS is not signaling an intent to pursue transformational new models at this point.
Elizabeth Fowler brings combination of Capitol Hill, White House and pharma industry experience to the role of director of the Center for Medicare and Medicaid Innovation.