This Weekly’s Hot Topics

  • Medicare regulations on bundling and unbundling of chemotherapy services. (Noridian News)
  • ATTENDthe 2017 ASH Meeting on Hematologic Malignancies (MHM) (Affiliate News)
  • Anthem/AIM prior authorization process for Oncotype Dx. (Industry News)

 

The Sacramento Bee published an op-ed from Deborah Goldberg, a mother living with cancer in Los Altos, about the importance of hope and innovation to those battling cancer, and the potentially negative impact of regulations like SB 17 on patients like Deborah. Deborah urges legislators not to support legislation that would stifle investment in innovation and take away the hope of new therapies for people with cancer. For more information click here and go to California News.

Recent CERT reviews have revealed errors regarding insufficient documentation for Chronic Care Management (CCM) services. For more information click here and go to Noridian News.

Specialty drugs can be covered under the pharmacy benefit, the medical benefit, or both depending on the benefit design of the payer. The medical benefit specialty drug pipeline is very robust with near-term (2016) oncology agents. For more information click here and go to DHCS/Medi-Cal News.

The Quality Payment Program’s first performance period began on January 1, 2017 and ends on December 31, 2017. Participation in MIPS can start as early as January 1, 2017 or as late as October 2, 2017. The first payment adjustments based on performance go into effect on January 1, 2019. CMS encourages subscribers of the PQRS listserv to sign up for the new CMS Quality Payment Program listserv. The Quality Payment Program is part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and includes two tracks — Advanced Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS). For more information click here and go to CMS News.

The 340B program provides an important safety net for high numbers of uninsured, poor, or vulnerable patients, by giving discounts on prescription drugs to certain hospitals and health clinics. Unfortunately, abuse of the 340B program is hurting the cancer care system and the very patients it is supposed to help – cancer patients, who face quotas, wait lists, and significantly higher costs for care at 340B hospitals. For more information click here and go to Affiliate Association News.

Genomic Health informs MOASC & ANCO of the new Anthem/AIM prior authorization process and how to complete a Prior Authorization request for Oncotype Dx.  Effective July 1, 2017, Anthem’s AIM subsidiary will perform Prior Authorizations (Pas) for all genomic tests. For more information click here and go to Industry News.

 

To view the complete California Oncology Weekly Newsletter, click on the date below.

 

August 29, 2017