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Although oncology medications hold great promise, costs for such treatments are rising rapidly, says Rebecca Shanahan, executive vice president and general manager of Aetna, Inc. subsidiary Aetna Specialty Pharmacy. She says that on a national basis, 50% of all specialty drug spending is on oncology medications and adjunctive therapies — and cancer medications are driving specialty spending up 20% per year. Shanahan spoke at an April 6 audioconference on "Oncology Management Strategies for Health Plans and Employers" sponsored by Atlantic Information Services, Inc.
One of the key focuses of Aetna Specialty Pharmacy is medication compliance, Shanahan says. She asserts that 94% of patients receiving drugs through specialty pharmacies are compliant, compared with just 53% of retail customers. To improve compliance, the insurer provides new patient teaching and assessment, injection training and support, compliance monitoring and physician communication.
Shanahan also identified se ...
HIP Health Plan last year introduced an oncology product preferencing program in the greater New York City area. The educational campaign was aimed at encouraging physicians to use medications that cost less, but are therapeutically equivalent, to higher-cost versions, says Araksi Sarafian, the insurer's vice president for pharmacy services. HIP identified about 30 drugs that represent more than half of its oncology drug spending.
The program was launched shortly after CMS adopted substantial changes in its reimbursement to physicians for care of Medicare beneficiaries with cancer. The agency reduced reimbursement to physicians for oncology drugs while increasing their reimbursement for administration and patient care.
The health plan partnered with ICORE Healthcare, an Orlando, Fla.-based injectable benefit management company, to operate the program. "We sent letters to physicians explaining how the program works so they would not be surprised with the fee schedules devised," Sa ...
Cancer DM programs are another strategy for helping to improve care and reduce costs for oncology patients. CIGNA expanded an existing specialized case management program to create its new oncology condition management program.
The old program was focused primarily on "high-acuity patients with cancer who are in active treatment or immediately post-treatment," says David Ferriss, M.D., national medical director of clinical program development for CIGNA HealthCare. "It has very much a specialty case management orientation and focus."
The new version takes a "very population-based approach to the whole spectrum of oncology," and includes elements of case management and DM, Ferriss says. It includes the specialized case management elements, "but really expands it across a much broader scope in terms of early detection and prevention," as well as surveillance of enrollees who now are in remission, he explains. The program was developed partly in response to employers that were pushin ...