The State of Cancer Care in America: Impact of State Policy on Access to High-Quality Cancer Care

Shifting regulatory authority from the federal government to states and the implications for patient access to high quality cancer care. Panel discussion at the NCCN Policy Summit: The State of Cancer Care in America: The Impact of State Policy on Access to High-Quality Cancer Care; June 27, 2019; Washington DC.

HHS.gov. What is the Affordable Care Act? Accessed September 25, 2019. Available at: https://www.hhs.gov/answers/affordable-care-act/what-is-the-affordable-care-act/index.html

Medicaid.gov. Section 1115 demonstrations. Accessed September 25, 2019. Available at: https://www.medicaid.gov/medicaid/section-1115-demonstrations/index.html

Neale B. Opportunities to promote work and community engagement among Medicaid beneficiaries. Accessed September 20, 2019. Available at: https://www.medicaid.gov/sites/default/files/federal-policy-guidance/downloads/smd18002.pdf

Kaiser Family Foundation. Tracking Section 1332 state innovation waivers. Accessed September 20, 2019. Available at: https://www.kff.org/health-reform/fact-sheet/tracking-section-1332-state-innovation-waivers/

Department of Health and Human Services (HHS). State relief and empowerment waivers. Accessed September 24, 2019. Available at: https://www.federalregister.gov/documents/2018/10/24/2018-23182/state-relief-and-empowerment-waivers

Centers for Medicare & Medicaid Services. Section 1332 state relief and empowerment waiver concepts: discussion paper. Accessed September 20, 2019. Available at: https://www.cms.gov/CCIIO/Programs-and-Initiatives/State-Innovation-Waivers/Downloads/Waiver-Concepts-Guidance.pdf

Sloan C, Rosacker N, Carpenter E. State-run reinsurance programs reduce ACA premiums by 19.9% on average. Accessed September 24, 2019. Available at: https://avalere.com/press-releases/state-run-reinsurance-programs-reduce-aca-premiums-by-19-9-on-average

Texas Health and Human Services. Report: independent evaluation of Texas' Uncompensated Care (UC) program and Delivery System Reform Incentive Payment (DSRIP) program. Accessed September 25, 2019. Available at: https://hhs.texas.gov/sites/default/files/documents/laws-regulations/reports-presentations/2016/eval-uncompensated-care-medicaid-payments-tx-hospitals-role-tx-uc-pool-aug-2016.pdf

Levy H, Buchmueller T. Health Michigan plan evaluation domain II – reduction in the number of uninsured. University of Michigan Institute for Healthcare Policy & Innovation. Accessed September 23, 2019. Available at: https://www.michigan.gov/documents/mdhhs/Domain_II_-_Reduction_in_Number_of_Uninsured_647135_7.pdf

Buchmueller T, Levy H, Nikpay S, Rhodes J. Healthy Michigan plan evaluation domain I – hospital uncompensated care. University of Michigan Institute for Healthcare Policy & Innovation. Accessed September 23, 2019. Available at: https://www.michigan.gov/documents/mdhhs/Domain_I_-_Reduction_in_Uncompensated_Care_647133_7.pdf

Sommers BD, Goldman AL, Blendon RJ, et al.. Medicaid work requirements — results from the first year in Arkansas. N Engl J Med 2019;381:1073–1082.

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Musumeci MB, Foutz J, Garfield R. How might older nonelderly Medicaid adults with disabilities be affected by work requirements in section 1115 waivers? Accessed September 23, 2019. Available at: https://www.kff.org/medicaid/issue-brief/how-might-older-nonelderly-medicaid-adults-with-disabilities-be-affected-by-work-requirements-in-section-1115-waivers/

United States Government Accountability Office. Medicaid demonstrations: evaluations yielded limited results, underscoring need for changes to federal policies and procedures. Accessed September 23, 2019. Available at: http://www.gao.gov

Keith K. The short-term, limited-duration coverage final rule: the background, the content, and what could come next. Accessed September 24, 2019. Available at: https://www.healthaffairs.org/do/10.1377/hblog20180801.169759/full/

Rudowitz R. 5 Key questions: Medicaid block grants & per capita caps. Accessed September 23, 2019. Available at: https://www.kff.org/medicaid/issue-brief/5-key-questions-medicaid-block-grants-per-capita-caps/

Trends in cancer care policy at the state level. Panel discussion at the NCCN Policy Summit: The State of Cancer Care in America: The Impact of State Policy on Access to High Quality Cancer Care; June 27, 2019; Washington, DC.

Schneider A, Searing A, Alker J, et al.. Medicaid and state budgets: checking the facts (yet again). Accessed September 26, 2019. Available at: https://ccf.georgetown.edu/2019/02/28/medicaid-and-state-budgets-checking-the-facts-yet-again/

Adamson BJ, Cohen AB, Estevez M, et al.. Affordable Care Act (ACA) Medicaid expansion impact on racial disparities in time to cancer treatment [abstract]. J Clin Oncol 2019;37(Suppl):Abstract LBA1.

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Texas Alliance for Health Care. The impact of uninsurance on Texas’ economy. Accessed September 10, 2019. Available at: http://wrgh.org/docs/The_Impact_of_Uninsurance_on_Texas_Economy_20190108.pdf

Massachusetts Health Policy Commission. 2018 Report on health care cost trends. Accessed September 10, 2019. Available at: https://www.mass.gov/doc/2018-report-on-health-care-cost-trends

Fischer MA, Avorn J. Step therapy—clinical algorithms, legislation, and optimal prescribing. JAMA 2017;317:801–802.

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Fink JL. Laws in 20 states address insurance-mandated step therapy. Accessed September 10, 2019. Available at: https://www.pharmacytimes.com/publications/issue/2019/july2019/laws-in-20-states-address-insurancemandated-step-therapy

National Psoriasis Foundation. Step therapy legislation by state. Accessed September 13, 2019. Available at: http://www.steptherapy.com/step-therapy-legislation-by-state/

LegiScan. TX SB680. Relating to step therapy protocols required by a health plan in connection with prescription drug coverage. Accessed September 10, 2019. Available at: https://legiscan.com/TX/text/SB680/id/1617322

The Ohio State Legislature. Permit health insurers to cover pharmacist-provided benefits. Accessed September 10, 2019. Available at: https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA132-SB-265

The Commonwealth of Massachusetts. Accessed September 10, 2019. Available at: https://malegislature.gov/Bills/191/H1853

Findlay S. States pass record number of laws to reel in drug prices. Accessed September 12, 2019. Available at: https://khn.org/news/states-pass-record-number-of-laws-to-reel-in-drug-prices/

Partnership to Improve Patient Care. Analysis finds ICER incorporates only 16% of feedback received from patient advocates into final value assessments. Accessed September 25, 2019. Available at: https://www.pipcpatients.org

Winegarden W. The ICER myth. Available at: https://static1.squarespace.com/static/5886319ba5790a66cf05d235/t/5ae0a7be575d1f3b350e155e/1524672450834/IfPA_The+ICER+Myth_April+2018+%281%29.pdf. Accessed March 2, 2020.

White N, Pace M. Is ICER our Robin Hood? The role of an independent HTA in the Sherwood Forest of US drug pricing. Accessed September 24, 2019. Available at: https://www.iconplc.com/

Zafar SY, Peppercorn JM, Schrag D, et al.. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 2013;18:381–390.

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National Governors Association. NGA brings together more than 100 health policy leaders to improve capacity for health care services. Accessed September 14, 2019. Available at: https://www.nga.org/news/press-releases/nga-brings-together-more-than-100-health-policy-leaders-to-improve-capacity-for-health-care-services/

Lesser M. The evolving role of states in ensuring access to high quality cancer care. Keynote at the NCCN Policy Summit: The State of Cancer Care in America: The Impact of State Policy on Access to High Quality Cancer Care; June 27, 2019; Washington, DC.

SB 398. An act concerning penalties for failure to comply with provisions governing the use of step therapy for prescription drugs. Open States. Accessed September 10, 2019. Available at: https://openstates.org/ct/bills/2018/SB398/

Wade K. Short-term, limited-duration health insurance policies. Bulletin HC-121. Accessed September 11, 2019. Available at: https://portal.ct.gov/-/media/CID/BulletinHC121pdf.pdf?la=en