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

Heath plan drug policies play a critical role in the care delivery process, to ensure that treatment decisions are based on clinical evidence and are in the patient’s best interests. While treating oncologists lead the decision-making process for determining the appropriate treatment regimen for their patients, health plans have an essential role to play in supporting this process by providing data and evidence to validate the decision for their members.

In oncology, implementing strong drug policies is critical due to the rapid innovation and pace of new cancer drugs and new indications that enter the market each day. However, the complexity associated with aggregating and analyzing drug data is a significant undertaking. For example, consider the following data points, which must be analyzed and consistently monitored in today’s oncology landscape:

  • Comparison to Other Drugs
    Comparisons can be made between existing cancer therapies in a similar space, based on efficacy, toxicity, and affordability. Health plans can use this information to direct steerage into policies, step therapy, biosimilar strategies, or preferred language. Dosing aspects driving cost must also be considered, such as quantity limits, dose rounding, vial size optimization, etc. Furthermore, decisions on whether supportive care agents are required to use the drugs must also be factored.

  • Adverse Reactions
    Well-written drug policies help to quickly quantify and compare side effects amongst the treatments a patient is eligible to receive. Health plans can help aid decisions by demonstrating which regimens will reproduce those same toxic effects and which regimens will not.

Another area that impacts oncology drug policies is clinical trials, which require health plans to have a strategy for both ongoing awareness and data aggregation.

  • Robust Knowledge of Clinical Trials
    To determine whether a patient is most likely to receive the benefits derived in a clinical trial, the patient needs to closely match the following criteria: age, ECOG Performance Status, line of therapy, previous agents received, histology, and genetic markers. When comparing results across clinical trials, the rigor of the trial is also considered: meaningful outcomes, such as overall survival, along with sound methodology and clinical phase (III vs. II).

  • Aggregation of Data Across Multiple Clinical Trials
    Every trial provides specific details about how the drug works and in what patient characteristics. The more time spent gathering this type of data, the better for adding details in the drug policy.

The growing number of cancer treatment options, combinations, and additional lines of therapy simultaneously increase the complexity of creating comprehensive drug policies.

Without investing in a team of board-certified oncologists, board-certified oncology pharmacists, data scientists, and researchers, how can health plans ensure they possess all of the data and analysis needed to develop comprehensive and effective oncology drug policies?

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 oncology pharmacists focus daily on evaluating and identifying new trends and researching appropriate therapy combinations. We have deep expertise in medical and pharmacy benefits as it relates to cancer drugs.

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 The National Comprehensive Cancer Network (NCCN) Compendium.

Oncology Analytics understands the complexity involved in the management of cancer treatment options and is committed to the ongoing review and analysis of oncology treatments, their outcomes, and adverse effects to ensure all oncology drug policies reflect coverage for the latest cancer therapies, which can provide patients the best possible outcome.

To learn more about how Oncology Analytics can help your organization implement strong oncology drug policies, please click here.

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