John L. Fox, MD: There is a lot of value in consulting with oncologists, including gynecologic oncologists, on how we manage drugs used to treat ovarian cancer. But to some extent, that depends on how we decide to provide access to those drugs. For example, if we decide to provide open access to those therapies, there’s not a lot of advantage in consulting with those physicians. On the other hand, if we’re trying to evaluate whether or not we should prefer one therapy over another, there are several things that we need to consider. First would be the efficacy, and we have pretty good data on the efficacy, but the toxicities of the therapies are a little more difficult to assess.
For example, in first-line ovarian cancer, physicians typically choose carboplatin over cisplatin because it has lower toxicity. They typically choose paclitaxel over docetaxel, simply because it has less myelosuppression. But paclitaxel also causes neuropathy, so that has to be weighed. Understanding the nuances from the physician's perspective is very important. Likewise, with the new PARP inhibitors, those have their toxicities, including nausea and vomiting, dysgeusia, and some myelosuppression. So, understanding the relative impact of those toxicities on drug choice is an important factor and one of the things we would want to talk to the oncologists about. But it’s also important for them, as they consider which therapies to cover, to talk about what the relative costs of those therapies are. If all things are equal, including the efficacy and the safety, they need to understand what the costs are to help inform their decisions as well.
In addition, some therapies are IV and some are oral, and different physicians have different preferences about which they think is going to be the most effective in a given patient. So, for us as a health plan, we’d like to consult the oncologists early during the process before we ever take things to the P&T (Pharmacy and Therapeutics) committee, so that we can get their insight on which factors are going to be most impactful in their decision making. Who do we use? It depends on the expertise that we have locally. We’re an integrated delivery system, so we tend to use the physicians who are available, but we’ll use anybody who we think has the expertise to help make us a better-informed decision than we would without their input.
The other reason to consult specialists is the changing reimbursement models. For example, the oncology care model from CMMI (Center for Medicare and Medicaid Innovation) puts physicians at greater risk for the total cost of care for patients. Currently, in that model, there’s just upside gainsharing if the providers reduce the costs. So, providers really need to critically evaluate not only the efficacy, the safety, and the associated toxicities, but also the cost of therapy.
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
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
Margin Status Likely Not a Factor in STS Recurrence
May 10th 2024The optimal negative margin required following surgical resection and perioperative radiotherapy for extremity soft tissue sarcoma (STS) remains up for debate, with investigators of a new study using Union for International Cancer Control classification to define resection margin.
Read More
A Focus on Women: AUA Best Posters Highlight Female Athletes, Prenatal Care, and Women in Urology
May 9th 2024Three posters from the American Urological Association (AUA) 2024 Annual Meeting focused on urinary incontinence in female athletes, prenatal care for fetuses with spina bifida in California, and the experiences of women residents at the Brady Urological Institute.
Read More