The US cancer care system faces many challenges, including:
- Growing number of cancer patients
- Growing number of cancer survivors
- Rising healthcare costs
- Oncology practice transformation1
Many of these challenges are directly related to the advances and evolution of cancer care in the US.
Nearly 40% of drugs in development are oncology medications, and these newer treatments are not cheap - 90% of oncology drugs approved in the last five years cost $20,000 for a three month cycle. As a result of the growing number of cases, in addition to the rising costs of treatment, the cost of prescriptions alone is projected to nearly double from $66 billion in 2011 to $130 billion in 2020.2 And with 1.6 million new cancer cases in 2012, at an average cost of $135,000 per case, cancer care is one of the most complex concerns for healthcare payers today.3
The utilization of oncology treatments such as chemotherapy and radiation along with advanced imaging is expected to increase by 30 to 60 percent through 2020.4 Evidence-based treatment protocols are used by payers and clinicians to help control utilization and minimize variation in patient care. However, oncology treatment can vary from physician to physician and across different sites of care, with studies indicating that approximately 32% of oncology treatment plans deviate from evidence-based guidelines.5
With increased utilization, there will be increased control by the payers over oncology treatments. MMIT is watching to see various strategies being employed to manage oncology costs, such as rebating and promoting the use of lowest cost therapies where there are equally efficacious treatment regimens. Additional utilization and clinical management techniques will include prior authorization, clinical pathways programs, and genetic testing requirements.
With many moving parts playing a role in the evolution of oncology care, pharmaceutical manufacturers are beginning to more closely monitor market access and restrictions for the various oncology classes to understand how coverage for their products is being impacted. Will your organization be able to understand its place in the market as payer control increases? With nearly one third of all oncology treatment plans deviating from evidence based guidelines, do you know what the landscape looks like for the large, medium, and regional players in your brand’s market?
1JOP JOP.2015.003772 published online 3/17/15.
2The Specialty Pharmacy Times, National Institutes of Health, and BioPharma Industry Reports.
3American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society; 2012.
4Community Oncology Alliance. Community Oncology Practice Impact Report: The Changing Landscape of Cancer Care. April 4, 2012. Washington, DC: COA; 2012.
5Forastiere A. Eviti: Decision Support at the Point of Care for Oncologists. Value-Based Cancer Care. June 2012. http://www.valuebasedcancer.com/node/1971