Oncology Practice in a Shifting Policy Landscape: The Role of State Affiliates

Chicago, IL—For the past 5 years, state affiliates have become galvanized by the issues facing oncologists, especially with the increased involvement and support of ASCO, said Tracey Weisberg, MD, President and Lead Physician, New England Cancer Specialists, Scarborough, ME, and Chair, ASCO State Affiliate Council, at the 2017 ASCO annual meeting practice management sessions. Dr Weisberg encouraged members to join their respective state societies and outlined the high-priority issues that have shaped recent discussions.

“The need is huge, and ASCO has developed very robust resources that help us in our states. Although the ASCO staff cannot be physically by our side at every moment that we need them, these tools help to leverage us and make us as impactful as possible,” said Dr Weisberg.

Hot Topics in 2017

According to Dr Weisberg, key topics under discussion include the safe handling of hazardous drugs, oral chemotherapy parity laws, and clinical pathways. The State Affiliate Council is also tracking multiple tobacco bills, changes in Medicaid coverage in clinical trials, human papillomavirus vaccination, prescription drug costs, biosimilars, the effect of brown bagging or white bagging on practices and patient care, prior authorization, specialty tiers, and step therapies. However, the first half of 2017 has been largely dominated by legislation pertaining to opioids.

Opioids

“There are currently over 400 bills in 46 states, and ASCO has helped all the state affiliates in meandering through this in the state legislatures,” said Dr Weisberg, who noted that the bills’ predominant concerns are limits on opioid prescriptions—either the dosing or the time—and prescriber requirements to query the Prescription Drug Monitoring Program.

Clinical Pathways

State affiliates have also voiced serious concerns regarding the development and use of clinical pathways. As a result of this discussion, ASCO developed a model bill as a resource for state affiliates and is offering advocacy assistance. The focus of the model legislation is on improving the development of clinical pathways and addressing practice burdens, said Dr Weisberg.

In 2017, 2 major clinical pathways bills were passed in 2 states—Connecticut House Bill 5960, to establish requirements for the use of clinical pathways by health carriers, and California Assembly Bill 1107, to improve the development of oncology clinical pathways by health plans. Although opposed by health plans, the latter bill passed out of committee, aided in large part by ASCO’s “tremendous support,” reported Dr Weisberg.

Right-to-Try Laws

Another hot topic for state affiliates is the right-to-try laws, which have been enacted by 34 states, with consideration for federal measures.

“This is a very impassioned topic for our patients who want to know why they can’t have a certain drug. These bills remove the Food and Drug Administration [FDA] review of safety and efficacy. Furthermore, there is no provision for IRB [Institutional Review Board]-associated patient protections and no systematic data collection on safety and efficacy, which could help all patients,” said Dr Weisberg, noting several legislative concerns.

Clinical Trials Criteria

ASCO is working with clinical trial sponsors and the FDA to relax the eligibility criteria for clinical trials to enable more patients to participate, explained Dr Weisberg. ASCO also launched the Targeted Agent and Profiling Utilization Registry and CancerLinQ to learn from patients and help build an evidence base for the delivery of high-quality cancer care, she said.

Parity Laws

Finally, state affiliates are advancing oral chemotherapy parity laws. Although oral chemotherapy parity laws are enacted in 42 states and in the District of Columbia, Dr Weisberg called these laws “incomplete,” for failing to address the armamentarium of new drugs that is coming down the pipeline. “There’s a need to update these laws to our current situation,” she reported.

“The State Affiliate Council is not just for community oncologists. It’s for everyone—whether you’re in private practice, a hospital practice, or academic practice. There are so many activities that directly impact you and your patients. Go seek them out and make your voice heard,” Dr Weisberg urged the audience.

New State Advocacy Resources

Dr Weisberg encouraged attendees to visit the ASCO website for various state advocacy resources. For example, the State Advocacy page (www.asco.org/advocacy-policy/advocacy-center/state-advocacy) lists legislative issues in all states and provides State Cancer Fact Sheets that detail how these issues affect cancer care. In addition, the State ACT Network offers a State Legislative Tracking Map (http://cqrcengage.­com/asco/state?1) that tracks the status of key bills in each state. Letters to legislatures are accessible for download as templates.

Finally, ASCO offers several advocacy tool kits in various areas, including opioids, clinical pathways, oral chemotherapy parity laws, the safe handling of hazardous drugs, step therapy, prior authorization, and specialty tiers.

“If you are called upon to testify in your state or need a rapid resource regarding how to make a cogent argument on an actionable concern, these tool kits are excellent references. ASCO’s policy statements are included, and ASCO staff will help coach you on the phone about how to be more impactful,” said Dr Weisberg.

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