Payers Must Adopt New Agents, Pathways in Order to Improve Oncology Care

The emergence of new treatment options requires payers to expeditiously evaluate and adopt newer agents and pathways as they become available, according to research presented at the National Association of Specialty Pharmacy Annual Meeting & Expo 2017.

“Unlike other conditions cancer is treated by a variety of specialists,” Richard Brook, president of Better Health Worldwide, Inc, and coauthor of the study, told First Report Managed Care. “In large part because cancer isn’t a single condition, but rather a variety of conditions. When health plans think about cancer, lung cancer is near the top of the list of concerns, followed by breast, colon and rectal, and prostate. Cancers like thyroid cancers and endometrial cancers are near the bottom of the list of their concerns. As new therapies come to market for these cancers, and survival continues to increase, cancer management costs are extended and are a growing concern for the pharmacy budget.” 

The researchers survey medical and pharmacy directors to gauge their perspective on the top concerns facing payers regarding cancer management. They also gathered perspectives on forecasted budgetary concerns for today and 5 years in the future.

In the survey, oncology tied for the top ranked specialty pharmacy concern facing payers. Lung cancer ranked as the most concerning oncology disorder, followed by breast cancer, colon and rectal cancers, and prostate cancer.

Furthermore, the researchers found that 48.7% of medical directors leave oncologists alone, 65% follow NCCN guidelines, 56.4% follow other guidelines and pathways, and 38.5% sometimes follow internal company protocols. 

In terms of budget impact, the researchers noted that oncology care was consistently reported as the leading concern. 

“Overall, cancer care is still largely managed by specialists with limited control from the health plans,” Mr Brook said. “While cancer care cost is expected to decrease as a top concern from a medical point of view, it is expected to be an increased concern from a budgetary point of view.”

In his presentation, Mr Brook concluded that “the shift from traditional chemotherapies toward targeted immunotherapies and the potential cost implications requires payer medical and pharmacy directors to focus on, adapt, and evaluate newer agents and pathways rapidly as they become available.”

—David Costill