Oncology therapy has the potential to become the single leading category promoting drug spending growth, however, the class
of drugs is rife with challenges for plans and employers.
The oncology category will be particularly challenging, because it is not only projected to be the top single category driving
drug spend growth, but also a challenge clinically to manage patients within this category, according to Ryan Haynes, RPh,
director of clinical services at HealthTrans, Greenwood Village, Colo.
"To further complicate the situation, it is often difficult to apply traditional cost management tools—for example, prior
authorization, step therapy—to oncology, because timely patient care is critical and with new oncology drugs becoming available
there can be uncertainty as to their place in therapy, not to mention the potential political ramifications surrounding new
and appropriate therapies in this category," he says. "Managed care executives will continue to be challenged with attempting
to balance appropriate, evidence based care with financial considerations involved with new drug therapy."
Kathryn Lindhorst Canaday, PharmD, director, pharmacy analysis, Pharmaceutical Strategies Group (PSG), based in Dallas, agrees
that the oncology drugs will remain a difficult class to manage for plans and employers. "Specialty injectable products will
continue to be covered under the medical benefit and administered in oncologists' offices and infusion centers," she explains.
"Moving these drugs over to dispersion by specialty pharmacies has not been a scenario that payers are eager for. Moving the
adjunctive agents, such as those for anemia, white blood cell growth or nausea, to the pharmacy benefit will increase as payers
appreciate the savings the pharmacy benefit allows them to receive."
