Differences Over Pathways Developed by Oncologists and MCOs May Create Conflict Over Prescribing Decisions in Early-Line Treatment
Clinical Pathways Developed by Oncologists Tend to Focus on the More Advanced Stages of Cancer, According to a New Report from Decision Resources
BURLINGTON, Mass., Aug. 28, 2013 /PRNewswire/ — Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that clinical pathways developed by physician groups are not preventing oncologists from prescribing their preferred therapies for advanced non-small-cell lung cancer (NSCLC), but that pathways developed by managed care organizations (MCOs) are more restrictive. Seventy-two percent of surveyed oncologists currently participating in a clinical pathways program for stage IV nonsquamous (NSQ) NSCLC indicated that both Roche/Genentech/Chugai’s Avastin and Roche’s Tarceva were permitted in the first line while 66 percent reported that Pfizer’s Xalkori was permitted in this line. In general, these responses did not differ materially from the percentage of oncologists that would prefer to prescribe these drugs in these lines in the absence of clinical pathways. In contrast, less than a third of surveyed MCO pharmacy directors/medical directors whose plans are involved in pathways indicated these drugs were permitted in this line of therapy.
The U.S. Physician and Payer Forum report entitled Impact of Payer-Imposed Strategies on Market Access in NSCLC and Prostate Cancer: Clinical Pathways, Bundled Payments, and Accountable Care Organization Contracting finds that clinical pathways developed by oncologists tend to focus on the more advanced stages of cancer, such as stage IV NSQ and squamous NSCLC. MCOs, however, are focusing their efforts on less advanced NSCLC and prostate cancer. MCOs that do have pathways in place for more advanced cancer tend to present narrower lists of permitted therapies, which could create conflict among oncologists who wish to prescribe off pathway. In fact, this concern over their prescribing was listed among the key challenges for oncologists currently taking part in pathways.
The report also finds that bundled payments and accountable care organizations (ACOs) appear to be growing in prominence as MCOs seek to control costs. Often tied to chemotherapy and other therapies, bundled payments also commonly cover physician visits, hospitalizations and radiology. Surveyed payers believe that bundled payments can achieve reduced drug spending of 16 percent and medical spending of 17 percent, likely stemming from a focus on more cost-effective treatment.
“Payers want to control their costs in NSCLC and prostate cancer and these strategies will likely affect prescribing decisions. Across clinical pathways, bundled payments and ACOs, we see that payers see substantial potential to reduce costs without hurting outcomes,” said Decision Resources Senior Director Roy Moore. “To achieve these goals, oncologists will likely be urged to change their prescribing decisions, particularly around the use of branded therapies and generics. Marketers of branded therapies must therefore cater their marketing strategies to these themes or risk reduced prescribing from oncologists.”
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SOURCE Decision Resources