Oncology Newsfeed

CMS Issues CY 2019 Proposed Rule Aimed at Efficiency, Transparency, Clinician Burden

On September 17, the Centers for Medicare & Medicaid Services (CMS) released the Medicare & Medicaid; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction proposed rule for calendar year 2019. This proposed rule was released to build upon the administration’s ‘Patients Over Paperwork’ and ‘Cut the Red Tape’ initiatives. The deadline for submitting comments on the proposed rule is 60 days from the rule's release into the US Federal Register.

ACCC is currently analyzing the rule and will provide an update to members soon.

View the proposed CY 2019 rule.

House of Representatives Passes Transparency Reforms to Medicare LCDs

• Open and recorded Medicare Administrative Contractor (MAC) Carrier Advisory Committee meetings
• Upfront disclosure of evidence MACs consider when drafting an LCD, as well as the rationale they are relying on to deny coverage.
• Additional options for challenging an LCD
• Annual reports to Congress on the number of LCD appeals and actions taken in lieu of the creation of an ombudsman.

FDA Approves New Treatment for Hairy Cell Leukemia

CMS Supports North Carolina and South Carolina Ahead of Hurricane Florence

The Centers for Medicare & Medicaid Services (CMS) have announced efforts underway to support North Carolina and South Carolina in response to Hurricane Florence. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of Hurricane Florence. CMS has waived certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; created special enrollment opportunities for individuals to access healthcare immediately; and taken steps to ensure dialysis patients obtain critical services.

•  Waivers for Hospitals and other Healthcare Facilities: CMS has temporarily waived or modified certain Medicare, Medicaid, and CHIP requirements. CMS issued a number of blanket waivers, listed on the website below, and the CMS Regional Offices have granted other provider-specific requests for specific types of hospitals and other facilities in North Carolina and South Carolina. These waivers work to provide continued access to care for beneficiaries. For more information on the waivers CMS granted, visit www.cms.gov/emergency.
• Special Enrollment Opportunities for Hurricane Victims:  CMS has made available special enrollment periods for all Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This gives people impacted by the hurricane the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the Exchange immediately if eligible for the special enrollment period. For more information on these special enrollment periods, visit:
      - https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/8-9-natural-disaster-SEP.pdf
      - https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Past-Emergencies/Hurricanes-and-tropical-storms.html
  
• Disaster Preparedness Toolkit for State Medicaid Agencies: CMS developed an inventory of Medicaid and CHIP flexibilities and authorities available to states in the event of a disaster. For more information and to access the toolkit, visit https://www.medicaid.gov/state-resource-center/disaster-response-toolkit/index.html.
  
• Dialysis Care: CMS is helping patients obtain access to critical services. The Kidney Community Emergency Response (KCER) program has been activated ahead of the storm and is working with the End Stage Renal Disease Network of the South Atlantic, ESRD NW 6, to assess the status of dialysis facilities in the potentially impacted areas related to generators, alternate water supplies, education and materials for patients, and more. They are also assisting patients who have evacuated ahead of the storm to receive dialysis services in the location to which they are evacuating. The ESRD NW toll-free hotline is 800-524-7139 and the KCER hotline is 866-901-3773. Additional information is available on the KCER website www.kcercoalition.com.
  
• Medical equipment and supplies replacements: CMS temporarily suspended certain requirements necessary for Medicare beneficiaries who have lost or realized damage to their durable medical equipment, prosthetics, orthotics, and supplies as a result of the hurricane. This will help to make sure that beneficiaries can continue to access necessary medical equipment and supplies. Medicare beneficiaries can contact 1-800-MEDICARE (1-800-633-4227) for assistance.
  
• Suspension of Enforcement Activities: CMS will suspend current survey and enforcement activities for healthcare facilities in North Carolina and South Carolina, but will continue to investigate allegations of immediate threat to patient health and safety.
  
• Ensuring Access to Care in Medicare Advantage and Part D.  During a public health emergency, Medicare Advantage Organizations and Part D Plan sponsors must take steps to maintain access to covered benefits for beneficiaries in affected areas. These steps include allowing Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities and waiving, in full, requirements for gatekeeper referrals where applicable.

For more information, visit www.cms.gov/emergency.

Posted 9/13/2018

AACR Releases Annual Cancer Progress Report

On September 12, the American Association for Cancer Research (AACR) released its annual Cancer Progress Report highlighting how federally funded research discoveries are fueling the development of new and even more effective ways to prevent, detect, diagnose, and treat cancer.

Key advances outlined in the AACR Cancer Progress Report 2018 include the following:

• Twenty-two treatments for cancer were approved for the first time by the U.S. Food and Drug Administration (FDA) or approved for new types of cancer between Aug. 1, 2017, and July 31, 2018. Among these treatments are revolutionary new immunotherapeutics called CAR T–cell therapies, exciting new targeted radiotherapeutics, and numerous new targeted therapeutics that are expanding the scope of precision medicine.
• The U.S. cancer death rate declined by 26 percent for adults from 1991 to 2015, a reduction that translates into almost 2.4 million lives saved, according to the latest data.
• The cigarette smoking rate among U.S. adults has fallen to 14 percent, down from 42 percent in 1965, thanks to public education and important policy initiatives.

Read the full Cancer Progress Report for more information.

Posted 9/13/2018

ACCC Submits Comments to CY2019 Proposed PFS Rule

Three Foundations Commit 30 Million Dollars to Nonprofit Generic Drug Company

CMS Issues Changes to Part D Formulary Options in 2020

On Wednesday, August 29, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a memo to Medicare Part D plans that will allow these plans to implement “indication-based formulary design” starting in 2020.

Currently, if a Part D plan includes a specific drug on its formulary, the plan must cover that drug for every FDA-approved indication, or patient condition, even if the plan would otherwise instead cover a different drug for a particular indication.

The CMS memo states that if a Part D plan limits formulary coverage of a drug to certain indications, the plan must ensure that there are other therapeutically similar drugs on formulary for the drug’s non-covered indications. 

The ACCC policy team is currently reviewing this policy change.

Read the CMS memo to Part D plans.
Read the agency's fact sheet.

Posted 8/29/2018

FDA Approves Ibrutinib Plus Rituximab for Rare Blood Cancer

FDA Approves Pembrolizumab + Chemotherapy for NSqNSCLC

Pembrolizumab was previously granted accelerated approval for this indication in May 2017 based on improvements in overall response rate and progression-free survival for patients randomized to pembrolizumab administered with pemetrexed and carboplatin as compared with pemetrexed and carboplatin alone in the KEYNOTE-021 study. This approval represents fulfillment of a postmarketing commitment demonstrating the clinical benefit of this product.

Read the full FDA announcement here.

Posted 8/20/2018