Managing Cancer Care: Strategies to Improve Outcomes and Lower Costs

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As health care costs continue to swell, one of the most costly — and complicated — kinds of health care expenses is oncology care. Such treatments cost about $200 billion annually, with costs growing each year. While manufacturers have made tremendous strides in treating various types of cancers and their side effects, these therapies come at a high price for payers.

Managing Cancer Care: Strategies to Improve Outcomes and Lower Costs examines some of the management strategies and pricing methodologies that health plans have been instituting in hopes of reining in costs, as well as the federal government’s role in reimbursement.

Filled with articles on recent developments from companies leading the way in oncology management — including an extensive presentation from Aetna Specialty Pharmacy with facts, figures and program design details — this valuable report provides insight on the programs health plans and PBMs have put in place, and how payers are responding.

Against a backdrop of great emotional drain on patients and their families, these fast-changing business conditions are demanding that health plans devote increasing attention to oncology management. Managing Cancer Care: Strategies to Improve Outcomes and Lower Costs paints a clear picture of the issues facing this market. Order your copy today!

 

Table of Contents

Introduction

1. Oncology Cost/Reimbursement Issues

• With Its Entrance to Anti-Emetic Market, Generic Zofran Draw Payers’ Interest
• Medicare Pricing Offers Extra Incentive for Ondansetron Use
• Payers Use Drug Discounts, SP Networks to Curb Oncology Costs
• Effective Oncology Management Strategies for Health Plans
• Some Providers Learn to Live With CAP; Vendor Earns CMS’s Respect
• Drilling Down on Cell-Stimulating Factor Data May Decrease Costs, Improve Care
• Federal Government Takes an Interest in Anemia Drugs
• How Much of CSFs Should Be Used?
• Experts: Having Medical Policy, Auditing Use Help Ensure Proper Herceptin Prescribing
• What Are Plans Doing on Herceptin?
• OIG Report Says Part B Pay for Oncology Drugs Could Be Cut
• Experts Offer Advice, Data on Managing Oncology Drug Spend
• Aetna Specialty Pharmacy: The Integrated Solution
• Payer Strategies for Navigating Oncology Market Challenges

2. Oncology Management Strategies

• Many Plans Covering Tykerb Are Also Using Prior Authorization
• UnitedHealthcare Carves Out, Takes Three-Pronged Approach to Oncology
• Concern Grows on ESAs as Studies Show Rise in Deaths; USP DI Delists One Use
• ESAs Represent Huge Financial Expense
• Specialty Pharmacy Distributors Sign New Oncology Deals
• ICORE Summit Identifies New Direction for Oncology Management
• Interest in Oncology DM Increases, but Only as Part of One-Stop Shopping Solution
• The Cancer DM Market: What It Is, and What It Isn’t
• Medicare Brings Opportunities for SPs in Oncology Management

3. Oncology Market Report

• Clinical Data Launches Rituximab Diagnostic Test for NHL Patients
• UHC Covers Oncotype Dx Test
• Aetna Sets Payment Rates for Breast Cancer Diagnostic Test
• Focus on Pyschosocial Oncology Increases; Reimbursement, Other Challenges Exist
• How Are Payers Handling Psychosocial Oncology Coverage?
• Drug Appropriateness, Oral Drugs Pose Major Oncology Concerns
• OTN Survey: Community-Based Oncologists Support P4P, EMRs
• Just-Formed Oncology Specialty Pharmacy May Be Indicative of New Focus in Industry
• ICORE Deal May Be Sign of New Component In Specialty Pharmacy Acquisition Market
• Great-West Unveils Study on Oncology Product Preferencing
• Cancer Drug Costs, Treatments, Concerns Continue to Increase
• More MCOs Are Focusing on Oncology Strategies

 

Written By

This book was written by the editorial staff of AIS.

The presentation from Aetna Specialty Pharmacy was written by Rebecca M. Shanahan, executive vice president and general manager of Aetna Specialty Pharmacy, which she helped start up in 2005. Aetna Specialty Pharmacy dispenses specialty pharmaceuticals and, through clinical informatics and therapy management, supports patients' adherence, persistence and compliance on more than 1,000 oral, injectable and infusible therapies. From 2002 to 2005, Ms. Shanahan served as executive vice president for Priority Healthcare Corp., where she had numerous responsibilities, including strategic initiatives for Priority. Her portfolio of responsibilities included strategic partnerships, corporate development, acquisitions and mergers, legal services, payer relations and sales, reimbursement and government services.

 

Written For

 

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Related Publications

• Specialty Pharmacy News
• Specialty Pharmacy: Stakeholders, Strategies and Markets
• Drug Benefit News
• Oncology Drug Management: A White Paper on Marketplace Challenges, Opportunities and Strategies
• Health Plan Week

 

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