Featuring excerpts used with permission from “Trends in Oncology Management: Oncology Care Model and Innovative Management Strategies.” Authors: Rebecca Borgert, PharmD and Michael Polson, PharmD, MS. The full article can be found in the latest Spring 2019 issue of the Magellan Rx Report.
The pace of innovation in the oncology arena is seemingly unmatched by any other therapeutic area in the pharmaceutical pipeline, and it continues to accelerate. In the past five years, the Food and Drug Administration (FDA) has approved more than 60 novel cancer drugs that have impacted the way we treat more than 20 different cancer types.1
Oncology and oncology support drugs make up 43% of total medical pharmacy spend in Commercial and 58% in Medicare.
While recent developments in the pipeline present significant advancements in the treatment of a wide variety of cancers, they also present significant challenges to payers due to the high costs associated with them.2 When chimeric antigen receptor therapy (CAR-T) came to market, it sent shockwaves through payer and provider communities with their unprecedented high costs for a one-time intravenous infusion. Payers were motivated to change the way they managed oncology agents to ensure lifesaving innovations such as these would be available to the patients that needed them.2
By 2022, the number of billion-dollar drugs will rise by 26% from 34 drugs in 2017 to 43 drugs in 2022. Within oncology, CAR-T alone is expected to increase 530% from $0.10 PMPM in 2018 to $0.63 in 2022.
Historically, many payers have refrained from tightly managing oncology agents for a number of reasons, including the seriousness of the disease as well as the fact that oncology agents generally fell under the medical benefit.3,4 For many payers, the pharmacy and medical benefits worked in silos, and drugs billed under the medical benefit went largely unmanaged.
Most commercial payers surveyed are still not taking advantage of cost-saving medical benefit drug utilization management (UM) programs:
- 68% do not have vial rounding procedures
- 69% do not have weight-based dosing measures for the check point inhibitors
The cost of cancer care in the U.S. is approaching $150 billion annually, and it is projected to reach $180 billion annually in 2020.1 As a result, the need for innovative strategies to mitigate the financial impact of these high-cost healthcare expenditures is greater than ever. With the increasing use of highly targeted and personalized therapy, the management of cancer is becoming more complex and expensive.
For over 14 years, Magellan Rx Management has provided customers with cost-effective strategies for medical benefit drug management, including medical oncology spend, while supporting nearly 14 million members with leading-edge programs. We are committed to providing forward-thinking solutions that provide cost savings while addressing the complex care needs for members undergoing cancer treatment.
- Recently, Magellan Rx announced the launch of a medical pharmacy solution to prepare customers, members, and providers for the expected 2019 market entry of oncology biosimilars.
- Additionally, results from an innovative solution to control costs for medical benefit oncology drugs through drug wastage protocol show significant savings of $46M within the first year for participating health plans.
- Another example of Magellan Rx’s dedication to improving the quality of life for members with cancer is our Oncology Care Management program. This patient-centric approach provides interdisciplinary support to patients and their family members to address the complex clinical issues faced by patients who receive a cancer diagnosis. Our clinicians collaborate with the patient’s provider to ensure the patient’s needs are addressed throughout the continuum of care.
Looking for more insights? Check out the top 10 pharmacy trends you need to know in 2019.
- Global Oncology Trends. IQVIA Institute. 2018 May 24. https://www.iqvia.com/institute/reports/global-oncology-trends-2018. Accessed 24 Apr 2019.
- Caffrey M. With Approval of CAR T-cell Therapy, Comes the Next Challenge: Payer Coverage. American Journal of Managed Care. 2018 Feb 21. https://www.ajmc.com/journals/evidence-based-oncology/2018/february-2018/with-approval-of-car-tcell-therapy-comes-the-next-challenge-payer-coverage. Accessed 24 Apr 2019.
- Macher D., Brow M. Payer Trends in Oncology. Avalere. 2018 Jan 23. https://avalere.com/insights/payer-trends-in-oncology. Accessed 24 Apr 2019.
- Furlow B. Rapid Oncology Innovation Raises Management Challenges for Payers. Managed Healthcare Executive. 2017 March 31. https://www.managedhealthcareexecutive.com/healthdisease-strategy/rapid-oncology-innovation-raises-management-challenges-payers. Accessed 24 Apr 2019.