The following article is the third in a five-part series on The Top Five Ways for Health Plans to Manage Oncology Drug Costs While Improving Member Treatment Options

Since 2018, the FDA approved 121 new cancer indications, including 49 novel cancer drug entities. The FDA has even launched a Real-Time Oncology Review (RTOR) program, which allows the FDA to review early drug data in advance of a formal application. Under this program, one oncology drug gained FDA approval within two weeks of the application filing.

When it comes to making coverage determinations, checking the box that a cancer therapy is supported by the National Comprehensive Cancer Network (NCCN) alone is no longer enough. With so many NCCN supported options, health plans need to ensure their providers choose the most cost-effective option, tailored to deliver the best outcome for the patient’s specific cancer.

Oncology Analytics can provide your health plan with real-time oncology expertise as an extension of your internal teams, for a fraction of the cost of doing it yourself. Our board-certified oncologists, radiation oncologists, hematologists, and pharmacists focus daily on evaluating and identifying new trends and researching appropriate therapy combinations. We are experts in oncology medical and pharmacy benefits as it relates to cancer drugs.

We take a more comprehensive approach by reviewing not only NCCN but also FDA approvals and peer-reviewed journals using the Centers for Medicare & Medicaid Services (CMS) coverage rules. We utilize the guidance of our internal oncologists, who have decades of experience caring for patients.

At Oncology Analytics, each oncology review is evaluated using a patient-first approach, which balances the specific clinical need of each patient against comorbidities, toxicities, and cost. In addition, our data science teams utilize advanced data models and machine learning to better understand outcomes in all areas of cancer treatment to ensure that your members receive the right treatment at the right time and at the right cost. This approach facilitates our ability to provide treatment recommendations that reflect the most current evidence-based findings, even when there is a delay between when research is presented and its inclusion in NCCN.

Oncology Analytics understands the complexity involved in the management of cancer treatment options caused by the rapid pace of research and new drug introductions that are changing the oncology landscape daily. We are committed to the ongoing review and analysis of oncology treatments, their outcomes, and adverse effects to ensure that all cancer treatment recommendations provide the patient with the opportunity to achieve the best possible outcome.

If you would like to contact one of our oncology specialists to discuss strategies to help your organization go beyond NCCN to keep current on new and emerging cancer treatments, please click here.

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