As the cost of cancer care hits all-time highs, payers are engaging oncologists in ways to make treatment as cost-efficient as possible. Clinical pathways, bundled payments, and physician performance incentives are but a few of the ways payers and physicians are working to improve treatment outcomes while reducing unnecessary expenses.

But there’s an aspect to cancer care costs that is largely overlooked — and, often, out of the hands of physicians at the patient-care level: shortages of common oncology drugs. In a survey report presented at this summer’s American Society of Clinical Oncology annual meeting, 83% of oncologists said they had been unable to prescribe a preferred chemotherapy agent in the past six months because of drug shortages. Often, when the drug they want can’t be found, oncologists turn to a more expensive agent.

Most commonly reported shortages

Percentage of oncologists who experienced shortages with these drugs

Percentage of oncologists who experienced shortages with these drugs

Of the 210 oncologists who reported experiences with drug shortages, 38% substituted brand-name drugs for generic chemotherapy agents. Levoleucovorin (Fusilev), for instance, is a common substitution for leucovorin. Informally, some physicians told researchers that because of ongoing problems with the drug supply, they have begun to use the higher-cost drugs as their standard of care.

The methods used to deal with drug shortages not only drive up costs; respondents also acknowledged the potential for affecting treatment outcomes.

How did you adapt to the drug shortage?

Oncologists' adaptive strategies to deal with drug shortages

Source: Emanuel EJ, et al. Impact of oncology drug shortages. J Clin Oncol. 2013:31(suppl; abstr CRA6510).

The degree to which shortage protocols can minimize outlier costs is unknown, but there is clearly room for improvement. About 70% of respondents said they had received no formal guidance for drug allocation or substitution during shortages. Guidelines are more likely to exist at academic medical centers than at community-based practices. The lack of guidelines has implications for integrated health systems, ACOs, and payers working to make treatment cost-effective.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.