As payers continue to search for ways to reduce their drug spend, one health plan recently rolled out a dose reduction program for some oncology therapies. Anthem Blue Cross and Blue Shield is asking providers in certain situations to “voluntarily reduce the requested dose to the nearest whole vial,” according to provider newsletters. The policy went into effect July 1.
A review of the policy in Anthem provider bulletins across various states revealed that some, such as California, are restricted to Medicare Advantage plan members, but others, such as Missouri, simply refer to “members covered by Anthem Blue Cross and Blue Shield.”
More than 40 oncolytics are included in the program. At the start of the prior-authorization process, providers will be asked whether they will accept the dose reduction. If not, a follow-up question will ask what the provider’s clinical reasoning is. The questions will be asked only if the provider’s originally requested dose is within 10% of the nearest whole vial. The company is using the language “dose reduction to nearest whole vial” and “waste reduction” in its materials to describe the program.
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