05/21/2019

Important Oncology Related News

Comprehensive Strategy to Foster Innovation for Transformative Medical Technologies

On May 2, CMS Administrator Seema Verma for the first time walked through the agency’s comprehensive strategy to improve patients’ access to emerging technologies. The Administrator highlighted two specific actions.

First, for issuing HCPCS codes, CMS is changing the current process of allowing only one opportunity per year to apply for new Level II codes. The agency is moving to a process with quarterly opportunities to apply for drugs and semi-annual opportunities to apply for devices. CMS anticipates this will greatly improve the ability for technologies to move through the adoption curve.

Second, for technologies with CPT Category III codes (which are temporary codes used for emerging
technologies), CMS is clarifying that for technologies that do not fall under an existing Local Coverage
Determination (LCD), Medicare contractors are required to follow the transparent new LCD process for every local coverage decision, including reviewing the evidence with respect to the technology.

For More Information:
• Speech: Remarks by Administrator Seema Verma at the Medical Device Manufacturers Association
Annual Meeting
• LCD Modernization Process Qs & As

See the full text of this excerpted CMS Press Release (issued May 2).

CMS Final Rule Maintains Protections for Part D Beneficiaries with Cancer; Safeguards Still Needed Under Medicare Advantage and Part B

May 17, 2019 - “The American Society of Clinical Oncology (ASCO) applauds the Centers for Medicare & Medicaid Services (CMS) for listening to ASCO and other stakeholders by not finalizing a proposal that would have significantly impacted access to drugs within the Six Protected Classes." READ PRESS RELEASE

Community Oncology Alliance Launches Major National Campaign to Stop PBM Abuses and Highlight Patient Horror Stories

(COA) May 15, 2019 - The Community Oncology Alliance is launching a major national campaign to highlight the negative impact of pharmacy benefit managers (PBMs) on patients with cancer. The “PBM Abuses” campaign will ensure that PBM middlemen abuse of patients with cancer is not lost in policy deliberations in Washington. READ PRESS RELEASE

CMS Statement: Delay in Final Chimeric Antigen Receptor (CAR) T-cell therapy National Coverage Determination

May 17, 2019 - From a CMS spokesperson: “CMS will not be issuing a final National Coverage Determination on CAR T-cell therapy for cancer today, but a decision is forthcoming.” READ PRESS RELEASE

DHHS Managed Care Plan Contract Managers

Are you dealing with a wrongful denial between a Medicare or Medicaid Managed Care Plan?  Did you know you can engage the DHHS Managed Care Plan Contract Manager to help address the issue?  Below is an updated list and contact information for the DHHS Contract Managers and their assigned payers!