On June 15, 2022, the Supreme Court of the United States (SCOTUS) ruled in favor of hospitals over Medicare regarding a 340B reimbursement policy instituted in 2018 and unanimously decided that the almost 30% in cuts to Medicare outpatient drug payments for hospitals participating in the 340B drug pricing program was unlawful.
The OCM was a 5-year voluntary advanced payment model that the Centers for Medicare and Medicaid Services (CMS) developed through the Innovation Center (CMMI) beginning July 1, 2016. CMS changes to advanced payment models due to the COVID-19 Public Health Emergency turned it into a 6-year model, which ended June 30, 2022.
Janet Serluco addresses trends impacting access in cancer care and the innovative payment models being considered to pay for these high-cost therapies, as well as the need to focus on value of therapies in the oncology and gene therapy space to support access and reimbursement.
Janet Serluco, Vice President, Director, Payer Access Solutions, highlights the tremendous activity in oncology drug development. With 16 new oncology drugs approved by the FDA in 2017 alone, what strategies are payers adopting in future budget planning, and how do payers keep up with new oncology agents and expanding indications?
