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

If your dishwasher needed to be fixed, would you bring it to an auto mechanic? Probably not. Granted, the auto mechanic may possess a general understanding of how machines work; most people would want someone with specific knowledge of dishwashers to fix their issue.

Let’s think about this scenario in the context of prior authorizations for cancer treatments. When a health plan receives a treatment request for a member’s complex cancer diagnosis, should it be handled by a general medical professional or an oncologist? If you were the cancer patient waiting for the decision, who would you want to review and approve your treatment?

The debate over prior authorization is particularly important in oncology, where the wrong treatment approach may mean the difference between life and death. With a myriad of treatment approaches, breakthrough therapies coming to market at a brisk pace, and the high toxicity of some cancer drugs, getting it right is critical. With a larger proportion of costs for health services shifting to employees and consumers through higher co-pays, larger deductibles and narrow physician networks, it is vital that health plans, in partnership with providers, ensure that patients receive the safest, most effective care at the best possible price and outcome.

Without question, oncology presents unique challenges for prior authorization to be effective. One such example is access to current, evidence-based data and research to make the correct treatment recommendation. As cancer care continues to evolve, the growing number of treatment options, combinations, and additional lines of therapy significantly increases the decision-making complexity for oncologists. For example, it has been estimated that oncologists would need 29 hours a day[1] to keep up with the research and findings that enter the market daily. In just the last 24 months, there have been 32 new cancer therapies approved by the FDA. Partnering with a specialist that focuses exclusively on oncology provides a differentiator for health plans and their members.

In the early days of the 20th century, department store magnate John Wanamaker famously said, “I know that half of my advertising doesn’t work. The problem is that I don’t know which half.” Data science holds great promise if health plans can collect enough data about medical treatments and use that data effectively. The use of real-world data in the prior authorization review and decision-making process should be able to predict more accurately which treatments will be effective for a specific patient and which treatments won’t.

Oncology Analytics is a different kind of partner for oncology prior authorization. We provide access to current, evidence-based, disease-specific analytics on all cancer types and treatment options, backed by board-certified oncology physicians and pharmacists. 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.

Our comprehensive approach to prior authorization for oncology addresses the in-house resource constraints most health plans face by providing support in two critical areas:

Data-driven prior authorization, which is purpose-built for oncology and provides an in-depth evaluation and analysis of patients through the entire continuum of care, under the guidance of board-certified oncology physicians and pharmacists.

Deep analytics and insights into health plan cancer drug spend, which ensures that anti-cancer therapies are based on science and evidence-based protocols that are specific to the patient’s unique circumstances and needs.

A data science-based approach to prior authorization addresses the two biggest challenges for prior authorization in oncology: speed and evidence. This approach requires that patient cases reviewed by health plans are handled only by board-certified oncologists and oncology pharmacists to ensure that patients receive the “right” care, not just “quick” care.

To learn more about how Oncology Analytics can help your organization deploy an oncology-specific approach to prior authorization, please click here.

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[1] Alessandra Curioni-Fontecedro, A new era of oncology through artificial intelligence, ESMO Open 2017, May 15, 2017, https://esmoopen.bmj.com/content/2/2/e000198

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