Appropriate, Value-Based Care in Immuno-Oncology

The idea of cost of care should be simple, but buying healthcare is incredibly complex, states Andrew L. Pecora, MD. Most individuals do not think about the potential for developing cancer when they make healthcare-related decisions.

Payers have to consider premium costs and risk pools, and generally have to look at their actuarial budgets over 3 to 5 years. In order to make actuarially sound reimbursement decisions, it is important to look at the total cost of care. If a drug is expensive, but changes the natural course of the disease, it provides value, explains Pecora.

There are ways for oncologists to assist patients in getting appropriate coverage for their prescribed regimen. For patients with limited insurance coverage, there are patient-assistance programs. It is important for oncology practices to communicate with payers about their treatment decisions in advance and to ensure these entities that the care is appropriate.