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Conversation: Texas medical director

Medicare & Reimbursement Advisor Weekly, November 20, 2009

As a managed markets professional, I thought this comment from a medical director I spoke to this week might help you understand perspective on what gets attention and what could hurt product adoption. Barry Lachman, MD, medical director for Parkland Community HP, a Medicaid managed care plan in Texas, said medical directors in the Houston area are upset at MD Anderson Cancer Center for “aggressively promoting” proton beam therapy in the face of what Lachman said is still a lack of scientific evidence, although some commercial plans cover the therapy for certain cancer indications. Lachman said he bases most first-line health technology and drug decisions on Hayes, an evidence and literature source which rates therapy and technology products A through D. “If Hayes, for example, decided to rate Proton Beam a B, and Medicare didn’t exclude it, we would cover it right away.” Second-line decisions are based on Aetna, which the plan uses for prior authorizations as well.

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