In this first segment of a one-on-one interview, a part of the Oncology Stakeholders Summit, Spring 2015 series, Michael Kolodziej, MD, and Bruce Feinberg, DO, address some of the key issues payers face as they make coverage decisions on the new PD-1 drug class of immuno-oncology agents.
Dr Kolodziej, national medical director of oncology strategy for Aetna, points out that prescribing behavior has thus far reflected the indications tested during the clinical trial process and, to a lesser extent, where National Comprehensive Cancer Network (NCCN) places them in the treatment guidelines for melanoma and now non-small cell lung cancer. Similarly, payers’ coverage policies reflect approved labeling and the NCCN recommendations.
If they reach their fullest potential, PD-1 inhibitors may be used to target up to 30 different tumor types, says Dr Feinberg, vice president and chief medical officer of Cardinal Health Specialty Solutions. They both agree that a key challenge to successful treatment outcomes with PD-1 inhibitors and for appropriate coverage decision making will be overcoming the lack of biomarkers to determine who will most benefit with these agents.
Dr Feinberg emphasizes that the FDA labeling and NCCN recommendations restrict use of PD-1 agents to patients who have suffered relapses. He believes that the excitement over this drug class, on both the provider and patient levels, will drive the use of these agents earlier in treatment.
The problem, according to Dr Kolodziej, is that clinical evidence on the optimal use of PD-1 inhibitors may lag behind actual use. Such new drug classes, he thinks, may require reconsideration of the way evidence is collected to help not only informed patient care but also coverage policy.
Watch our related Peer Exchange, Oncology Stakeholders Summit, Spring 2015.
Navigating Health Literacy, Social Determinants, and Discrimination in National Health Plans
February 13th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the February 2024 issue of The American Journal of Managed Care® about their findings on how health plans can screen for health literacy, social determinants of health, and perceived health care discrimination.
Listen
Risk for Second Primary Melanoma Increases After Primary Melanoma Diagnosis as Men Age
March 28th 2024A population-based cohort study out of Norway has found that older men have a higher risk of developing second primary invasive melanoma following an initial primary melanoma, suggesting the benefits of increased surveillance in these patients.
Read More
Drs Raymond Thertulien, Joseph Mikhael on Racial Disparities in Multiple Myeloma Care Access
December 28th 2023In the wake of the 2023 American Society of Hematology Annual Meeting and Exposition, Raymond Thertulien, MD, PhD, of Novant Health, and Joseph Mikhael, MD, MEd, FRCPC, FACP, chief medical officer of the International Myeloma Foundation, discussed health equity research highlights from the meeting and drivers of racial disparities in multiple myeloma outcomes.
Listen
CMS released a final rule to help patients obtain Children’s Health Insurance Program (CHIP) coverage and issued a proposed rule to update Medicare payment policies and rates for inpatient rehabilitation facilities; debate over if gift card incentives are acceptable in health care marketing.
Read More