Rapid oncology innovation raises management challenges for payers
Operationalizing and implementing a value paradigm for cancer care remains a complex challenge, according to a speaker at the AMCP Managed Care & Specialty Pharmacy Annual Meeting, in Denver, during the March 30 session, “The Present and Future of Oncology Care Management.”
Oncology costs are rising, increasing pressure on management programs, but the heterogeneity of malignancies (even within a given cancer type) make it a “tricky” management challenge, said Jeremy Schafer, PharmD, MBA, senior vice president and director of specialty solutions at Precision for Value.
“There was a time when you just didn’t touch oncology as a payer,” he said. “A lot of life-and-death disease do not involve emotions as much as oncology. There is a high risk of pushback from patients and providers, and media exposure.”
Oncology has long been “medical-benefit heavy,” which can be more difficult to manage effectively than pharmacy benefits. But even pharmacy management is more complex for oncology than other diseases.
Under Medicare Part D regulation, oncology is a protected class and payers are required to accept clinical guidelines by professional bodies like the National Comprehensive Cancer Network (NCCN), Schafer said.
“That further limited your ability to aggressive manage in oncology,” he said. “A lot of oncology products have minimal competition; a lot of products have carved out niches that are unique.”
Now managers face a different challenge: the “dizzying” pace of innovation, Schafer said.
Innovation complicates oncology management
“There are 836 drugs and vaccines in the oncology pipeline—123 pipeline agents for lung cancer alone” he noted—80% of which are first-in-class agents. “A lot will fail, of course, but when you consider managing lung cancer in the future, that’s a pretty daunting prospect, especially when you consider how many of these agents are first-in-class.”
There is also rapid change for existing classes of agents, like PD-1/PD-L1 immune checkpoint blockade cancer immunotherapies, he said. “We’ve had three approved agents since 2014, with indications covered by at least one of these agents for non-small-cell lung cancer, head and neck cancer, melanoma, bladder cancer, renal cell carcinoma, and Hodgkin’s lymphoma.”
And additional indications—and combined-agent regimens—are in the PD-1/PD-L1 pipeline.
“It’s hard to chart out long-term strategies—even in a year, when the treatment paradigms are constantly upset and are going to change,” Schafer said.