Bhuvana Sagar, MD: In second-line therapy of lung cancer, we typically follow NCCN [National Comprehensive Cancer Network] guidelines. We have a patient decision support tool that we’ve put in place, which translates NCCN guidelines into an algorithm and walks the provider through what the next best test would be. For example, if the patient has an EGFR mutation and they have progression on Tarceva [erlotinib], it depends on what the provider wants to do next: if they want to order the next step, to see if the patient would be eligible for Tagrisso [osimertinib], or if they would prefer to do PD-1 inhibition. So, we leave that up to the physician and patient, and they have shared decision making at that point: understand expectations, what the patient’s performance status is, and how they think the patient is going to do. Of course, also understanding the toxicity profile and making sure the patient is able to tolerate the drug. All of those factors need to be taken into account when the treatment decision is being made. In some scenarios, best supportive care might be a good option. If the patient’s performance status is very poor and they feel that doing aggressive therapy is not the best option, we have studies, as published by Dr Jennifer Temel, which talked about doing best supportive care and actually adding survival.
At this time, in cancer care, drug costs continue to rise. The value of different therapies and the clinical utility of clinical therapies need to be taken into consideration. We all recognize that there’s no direct correlation between how the drug is being priced and what value the drug is actually adding to the patient’s care. By value I mean clinical utility and clinical benefit. Is it really adding survival benefit or quality-of-life improvements? There’s no direct correlation between if the drug is adding survival benefit and how it’s being priced. That being said, we have not made coverage policy decisions based on drug pricing just yet. I think that is something that all the payers and all the different stakeholders are looking at, considering the cost of care continues to rise. It is becoming unsustainable, truly.
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
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