Strategies to Reduce Oncology Care Costs — Without Sacrificing Outcomes

Table of Contents

Oncology Management Strategies

• UnitedHealthcare Will Base Some Oncology Drugs’ Coverage on NCCN Compendium
• How NCCN Develops Its Clinical-Practice Guidelines
• First-of-Its-Kind Payer-Physician Partnership Takes New Approach to ESA Authorization
• Regence Expands ESA Authorization Program to Two More Practices
• Multiple Myeloma Therapies, Costs Demand Health Plans’ Attention
• BCBSM Partners With Oncologists in Effort To Improve Outcomes, Increase Efficiency
• New US Oncology Division Helps Providers, Payers Work Together
• BCBSMA Improves Oncology Management With Program to Aid Outcomes, Cut Costs
• As Research in Genetic Testing Booms, Health Plans Should Create Guidelines
• Some Plans Take the Lead in Covering KRAS Testing, With Handful Making It Part of PA
• KRAS Testing Brings Cost Savings, Avoided Side Effects
• ImClone, Amgen Are Trying to Address KRAS Data With FDA
• Insurers’ Oncology Strategies Result in First-Year Savings
• Managed Care and Oncology (presentation from AIS’s January 2010 audioconference)
• Innovation That Drives Quality Wins In Oncology Care
• UHC Database Blends Clinical, Claims Data To Assess Oncology Care, Boost Outcomes

Oral Oncology Drugs

• Oral Oncolytics Bring Concerns About Management, Reimbursement
• Consider Various Management Strategies With Oral Oncolytics
• Emerging Trends in Oral Oncology
• Oral Oncology Drugs: Clinical Issues
• Oral Oncology Drugs: Benefit and Network Management
• Medicare Stand-alone Prescription Drug Plans Are Gradually Raising Coinsurance Amounts for Brand-Name Oral Anticancer Drugs
• Medicare PDPs Have Upped Curbs, Cost Sharing for Oral Oncolytics
• Medicare Stand-alone Prescription Drug Plans Have Increased Rates of Prior Authorization for Brand-Name Oral Antineoplastics Since 2006
• Oral Oncology Drugs Achieve Rapid Growth, But Perhaps Not Yet as Much as Expected
• Costs and Indications of Selected Oral Oncology Drugs as of October 2008
• Study: Save Costs With Tighter Management of Oral Oncologics
• Keep Tabs on Oral Oncology Drugs, Which Are Living Up to Hype of Escalating Growth
• Physicians, Payers Disagree on Oral Oncolytics’ Off-Label Use

Erythropoiesis-stimulating Agents

• More Action, Including Audits, on ESAs Is Possible From Medicare, Commercial Plans
• CMS Alters ESA Monitoring Policy; Bill Seeks Reimbursement Cuts
• ESA Legislative Activity Heats Up, Along With Regulatory Scrutiny
• New ESA Climate Offers Big Opportunity For Specialty Pharmacy Management
• Safety Concerns of Epoetin Products — Supporting the Best Outcomes in Cancer Patients
• FDA Is Reviewing New Data on ESA Risks With Some Cancers
• CMS Stance on ESAs Has Caused Adverse Outcomes, Two-Tier System, Oncologists Say
• FDA Approves REMS for ESAs Used in Cancer Patients
• REMS for Drugs Already on Market Will Mean Additional Challenges for Stakeholders

Oncology Market Report

• McKesson Bid for OTN Raises Oncology Market Stakes, Questions About Industry
• Company Brings Together Oncology Segments in Integrated Approach
• Oncology Firm Pledges Transparency, Efficiency via Online Electronic Negotiations
• How Do OneOncology’s Electronic Negotiations Work?
• Private Payers Can Learn From Government’s Oncology Experience
• Specialty Pharmacies Need Different Approach to Oncology
• As Focus Grows on Oncology Care, Quality Processes Are Needed
• Survey: Oncology Practices Say Reimbursement Has Decreased
• Teva Reportedly Will File BLA With FDA for Biosimilar in 2009
• Teva Submits BLA for Biosimilar, Then Files Lawsuit Against Amgen
• Hospital Begins Initiative to Genetically Profile All Tumors, But Are Plans On Board?
• CMS Denies Coverage for Cancer Test, Spurs Fears of Cost Criteria
• US Oncology Forms Joint Venture to Increase Access to Lab Tests
• Survey: Many Oncologists Weigh Drug Costs When Deciding on Treatment
• Coverage of Oral, IV Oncology Drugs Can Hinder Compliance
• Facing Pressures, Smaller Cancer Clinics Are Closing Their Doors, Impacting Plans

Written By

This book was written by the editorial staff of AIS. The audioconference presentation was written by Winston Wong, Pharm.D., associate vice president of pharmacy management at CareFirst BlueCross BlueShield, and Beckie Fenrick, Pharm.D., director of clinical pharmacy programs at Blue Cross Blue Shield of Florida, Inc.

Written For

Pharmacy, clinical services and medical directors; strategic planners; product development, contracting and marketing executives; and financial and operations executives at:

• Health plans
• Specialty pharmacies
• PBMs and pharmacy benefit administrators
• Pharmaceutical manufacturers
• Employers
• Group-purchasing organizations
• Physician groups
• Infusion suites
• Consulting firms
• Disease management companies
• Third-party administrators

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• Read the Introduction to this Report