California Oncology Weekly
"An Oncologists’ Source for Timely Information"
A publication of the
Medical Oncology Association of Southern California, Inc.


May 18, 2021
This Weekly's Hot Topics

  • Gov. Newsom proposes $1.5 billion program providing grants of up to $25,000 to small businesses in California. California News

  • H.R. 3258, the 72-hour bill, has been introduced. National News

  • Drug pricing bill introduced by House Democrats for negotiation under Medicare. National News

  • HHS looking at extending the June 30 deadline for providers to use federal assistance they have received from the COVID-19 Provider Relief Fund. National News
MOASC News

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California News
Gov. Gavin Newsom on Thursday proposed adding $1.5 billion to a program providing grants of up to $25,000 to small businesses harmed by the COVID-19 pandemic in California, allowing thousands more to get financial help. The additional funds from federal COVID-19 aid to the state would bring the amount allocated in recent months for grants to $4 billion, which Newsom told business leaders would make it the largest state program of its kind in the country.
Updates on the State Legislation MOASC has been supporting:
AB 342 Colorectal Screening. 4/14 referred to suspense file.
AB 347 Step Therapy. 4/28 referred to suspense file.
AB 1520 Prostate Screening Bill.  5/5 referred to suspense file.
SB310 Cancer Medication Access: Recycling Program. 4/19 referred to suspense file.
SB 535 Biomarker Testing. 5/10 referred to suspense file.
SCR 11 CA Patients’ Bill of Rights. In Assembly, held at desk.
SB 524 Health care coverage: Patient steering. Senate hearing scheduled for 5/17.
Medicare News 
Noridian News
May 11, MLN Connects Special Edition- CMS Expanding Efforts to Grow COVID-19 Vaccine Confidence and Uptake Amongst Nation's Most Vulnerable.
Noridian Programs
May 20, the COVID-19 Vaccine Administration and Billing for Part B Providers: this webinar will review the coverage, coding, and billing guidelines for COVID-19 vaccine administration and billing.
May 20, the Radiation Oncology webinar includes: Radiation Oncology Overview and Billing, Local Coverage Determinations (LCDs), Radiation Treatment Management, Noteworthy Information, Resources.
May 26, the Ordered, Referred, and Prescribed Services webinar includes: Ordering/Referring Requirements, Claim Editing for Ordering/Referring Provider, Ordering/Referring Services, Signature Requirements, Medical Records Documentation, Resources and Reminders.
May 26, Additional Documentation Request (ADR) Responsiveness webinar includes: ADR Inquiry, Submit Documents, Check Status, ADR Decision, Resources 
May 27, the Noridian Medicare Portal (NMP) Eligibility webinar includes: Hours of Availability, Eligibility, MBI Lookup, Resources 
June 3, the Modifier 59, National Correct Coding Initiative and Medically Unlikely Edits webinar includes: National Correct Coding Initiative (NCCI), Procedure to Procedure (PTP) CCI Edits, Modifier 59, Medically Unlikely Edits (MUEs), CCI Examples, Resources and Reminders.
June 16, the Provider Enrollment and Identity and Access: Connections Part 2 includes: Provider Enrollment and Identity and Access: Connections Part 2, Connections, Access Roles, Managing connections 
June 23, join the Live Chat with Provider Enrollment Webinar. The Noridian Provider Outreach and Education (POE) staff is hosting a Live Chat with Provider Enrollment. 
June 30, the Provider Enrollment Options: Opt Out, 855O and the 855I with R webinar includes: Provider Enrollment, Opt Out, CMS 855O, and CMS 855I with CMS 855R. 
CMS News
CMS issued a rule that will ensure long-term care facilities, and residential facilities serving clients with intellectual disabilities, educate and offer the COVID-19 vaccine to residents, clients, and staff. The rule also requires LTC facilities to report weekly COVID-19 vaccination status data for both residents and staff. The new vaccination reporting requirement will not only assist in monitoring uptake amongst residents and staff but will also aid in identifying facilities that may be in need of additional resources and/or assistance to respond to the COVID-19 pandemic.
National News
H.R. 3258, the 72-hour bill, has been introduced. The bill requires a cancer patient to get their oral drugs in 72 hours from the PBM/insurer – including any prior auth. If not, the patient can get the drugs from the practice as if in network with no penalties.
 
Last month, House Democrats introduced a drug pricing bill that would allow for negotiation under Medicare and apply those prices to commercial plans. It would also cap Medicare beneficiaries’ out-of-pocket costs at $2,000 per year. The bill faces an uphill battle in the Senate, and is now facing opposition from some moderates in the House.
 
HHS Secretary Xavier Becerra told a House panel the agency is looking at extending the June 30 deadline for hospitals and health care providers to use federal assistance they have received from the COVID-19 Provider Relief Fund. A number of stakeholders have asked HHS to extend the deadline and release the program's remaining funds. As of March 1, there was $24 billion in unused funds in the Provider Relief Fund. 
A bill proposed in the House last week would require Medicare Advantage plans to develop an electronic prior authorization process and submit data to the CMS on prior authorization use, approvals and denials. The legislation would also require HHS to establish a framework for real-time decisions regarding commonly approved items and services.
Palliative and hospice organizations are in talks with the Biden administration to expand palliative care as a permanent benefit in Medicare. Advocates are citing studies showing higher quality of life for patients, better pain management and lower health care costs with fewer hospitalizations.
 
The Institute for Clinical and Economic Review (ICER) today released a Final Evidence Report assessing the comparative clinical effectiveness and value of three new treatments targeting the B-cell maturation antigen (BCMA) for heavily pre-treated patients with triple class refractory multiple myeloma (TCRMM) who have cycled through numerous previous lines of therapy:
  • idecabtagene vicleucel (“ide-cel,” Abecma®, Bristol-Myers Squibb and bluebird bio), a chimeric antigen receptor (CAR) T-cell therapy that the FDA approved in March 2021 to treat TCRMM patients after four or more prior lines of therapy;
  • ciltacabtagene autoleucel (“cilta-cel,” Janssen and Legend Biotech), an investigational CAR T-cell therapy for which a rolling biologic license application (BLA) seeking approval for the treatment of adults with relapsed and refractory multiple myeloma was completed in the first quarter of 2021;
  • belantamab mafodotin-blmf (“belantamab,” Blenrep™, GlaxoSmithKline), which the FDA approved in August 2020 to treat TCRMM patients after four or more prior lines of therapy.
In the shadows of COVID-19, another crisis has emerged. Amid the damage is an untold number of cancers that went undiagnosed or untreated as patients postponed annual screenings, and as cancer clinics and hospitals suspended biopsies and chemotherapy and radiation treatments. 
 
Referrals to tobacco-cessation programs increased 26 times in six months after three adult rheumatology clinics began using an EHR-based electronic referral protocol for rheumatology patients. The referral process takes less than a minute and a half, and 24% of referred patients reported an attempt to quit tobacco, researchers reported in Arthritis Care & Research.
An EHR-embedded registry may help clinicians identify and close gaps in cardiovascular care for patients with cancer, according to a study in JMIR Cardio. The study authors also said EHR data can be used to populate a cardio-oncology registry quickly for research.
A free, online health care planner called Jasper curates articles about cancer and enables patients and their caregivers to keep track of appointments, to-do lists, daily symptoms and treatment side effects, then share the information with health care providers. The website, which also has a chat feature and product recommendations, has incorporated user feedback and is being launched publicly.
Affiliate Association News
ANCO News
ANCO announces a new series of events titled: ANCO Connections. This is a series of monthly roundtable presentations on the day-to-day issues of importance to the cancer community by local and national thought leaders. Hosted on the Spatial video chat platform, the hour-long real-time programs also include interactive questions and answers and networking breakout sessions, so attendees can talk about what they’ve heard.
National Cancer Survivors Day Foundation

On Sunday, June 6, 2021 – National Cancer Survivors Day® – cancer survivors and supporters around the world will unite to recognize cancer survivors, raise awareness of the ongoing challenges cancer survivors face, and celebrate life.
NCCN News

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), the NCCN Radiation Therapy Compendium™, and the NCCN Drugs and Biologics Compendium (NCCN Compendium®) for Breast Cancer. These NCCN Guidelines® are currently available as Version 4.2021.
NCCN has two upcoming patient webinars for people with cancer, their caregivers, and their families. The first is on advanced prostate cancer, the second is on pancreatic cancer. The webinars are designed to help participants understand their cancer, compare, discuss, and select treatment options with their doctor.
NCCS News
 
If you are a cancer survivor, NCCS needs your input for their 2021 State of Cancer Survivorship Survey. Your responses will help NCCS understand how they can better address the survivorship needs of patients and survivors. Your participation is important. The first 100 people to qualify and complete this survey will receive a $10 Amazon gift card. Please be assured that this is for research purposes only and your opinions will help inform NCCS’s future work. The survey will take approximately 15 minutes to complete. Responses will remain strictly confidential. The information you provide will only be viewed together with the responses of others. Your information will never be sold to a third party. This survey will only be online for a short period of time. Thank you.
Industry News
Bristol Myers Squibb announced that Opdivo (nivolumab) (injection for intravenous use), in combination with fluoropyrimidine- and platinum-containing chemotherapy, was approved by the FDA for the treatment of patients with advanced or metastatic gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma, regardless of PD-L1 expression status. The approval is based on the Phase 3 CheckMate -649 trial evaluating Opdivo in combination with mFOLFOX6 (fluorouracil, leucovorin, and oxaliplatin) or CapeOX (capecitabine and oxaliplatin), compared to chemotherapy (mFOLFOX6 or CapeOX) alone.
Coherus Biosciences announced that Blue Shield of California designated UDENYCA® the reference product, and pegfilgrastim-bmez as preferred pegfilgrastims covered under the Commercial Medical Benefit.
Industry Meetings
May 20, 2021, 6pm PDT, SeaGen cordially invites you to their virtual presentation to review data from HER2 Climb, a global, randomized, double-blind, controlled trial evaluating Tukysa (tucatinib) versus placebo, each in combination with trastuzumab and capecitabine. Presented by: John Glaspy, MD from UCLA. This presentation will review key highlights such as study design, patient characteristics as well as go over safety and efficacy data including PFS and OS and subgroup analysis for patients with and without brain metastases. We will also discuss the mechanism of action and well as the oral dosing schedule.
To RSVP, please contact Katie Adams at kaadams@seagen.com or 310-433-1680
May 25, Incyte presents the final of three live disease education webinars for patients diagnosed with a myeloproliferative neoplasm (MPN). Please share with your patients and peers.
Chart of the Week
The Medical Oncology Association of Southern California (MOASC) is a leading oncology society that advances and protects the ability of cancer patients to obtain, and the ability of the oncology physicians to provide, optimal cancer care. The material contained in the California Oncology Weekly is intended as general information for MOASC members. Because diagnostic, treatment, contracting, coding, and billing decisions should be made on a case-by-case basis, any such information contained in the California Oncology Weekly may not apply in any given situation. Members are encouraged to contact their own consultants or advisors to obtain specific advice on matters relating to contracting, coding, and billing. The information contained in California Oncology Weekly should not be used as a substitute for such advice. This publication provides a summary of regulations affecting oncology and its business practices. Reading this newsletter does not substitute for understanding regulations and verifying the validity of every claim. This information is time-sensitive and is subject to change. MOASC accepts no liability for any statements or articles herein. CPT codes are owned and trademarked by the American Medical Association. All Rights Reserved.