Bhuvana Sagar, MD: When new clinical trial evidence comes out, we do get alerts from the FDA. We get alerts through the American Society of Clinical Oncology e-mailers. We also get alerts through NCCN [National Comprehensive Cancer Network] flash updates. Any time a drug gets FDA approval or if there’s an NCCN guideline change, they immediately make a change in our coverage policy.
When we make a positive change for drug approvals—let’s say the FDA sends us an alert and we start covering the drug—we don’t make a specific outreach to the providers to let them know that we’re starting coverage for that particular indication. I think the providers also receive alerts from the FDA and ASCO when they sign up for them. So, we rely on that for the providers to be educated and able to place a request for drug authorization when new FDA approvals come out.
We have implemented a patient decision support tool in practice. The providers have access to a portal where they enter patient data. It collects detailed information on the patient’s performance status, age, and demographic information. It also collects information on their cancer subtype and all the other relevant details that are required to make a drug approval decision. Once that information is collected, it leads them to a list of choices that are in the NCCN guidelines. If the provider is able to pick one of those drug regimens, there’s an automatic authorization. In situations where the provider is not able to pick one of those regimens, for whatever clinical reason, and they want to deviate from one of the regimens that are in the guidelines, he or she has the availability to put in a custom regimen request. All of those requests will be reviewed, and the provider has the option to have a peer-to-peer discussion with a board-certified medical oncologist to understand any nuances that may be going on with that particular patient to see if there’s a reason for a clinically valid exception in that particular scenario. If there is a reasonable clinical reason, then we do allow an exception.
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Traditional Medicare Supplemental Insurance and the Rise of Medicare Advantage
May 7th 2024Rising Medicare Advantage enrollment occurred alongside declines in enrollment in traditional Medicare with employer-sponsored supplemental coverage and traditional Medicare without supplemental coverage.
Read More
Following Roe v Wade Overturn, Research Focuses on Male Contraceptives
May 6th 2024Stephanie T. Page, MD, PhD, UW Medicine Diabetes Institute, presented on ongoing research and growing interest in new male contraceptive options, such as an oral pill and a hormonal transdermal gel, at the American Urological Association 2024 Annual Meeting.
Read More