The American Society of Clinical Oncology (ASCO) has raised concerns that utilization management strategies, especially for high-cost prescription drugs, could reduce patient access.
Health plans often experiment with different models to identify optimal strategies on utilization management, especially high-cost prescription drugs. In its new policy statement, the American Society of Clinical Oncology (ASCO) has raised concerns that these strategies could reduce patient access.
Prior authorization (PA), clinical pathways, step-therapy protocols, restrictive formularies, and specialty tiers are some of the ways in which health insurance companies restrict use of prescription drugs. Such restrictions can prove problematic for patients being treated for cancer, because often there is a lack of interchangeable clinical options in oncology. Ensuring compliance with the different health plan policies is also a huge administrative investment for clinics, and to avoid this, ASCO, in collaboration with the American Medical Association, developed resource utilization principles to bring about reform with the process.
“Utilization management strategies, when implemented without appropriate patient safeguards, can impede patient access to high-value, clinically appropriate care,” said ASCO President Daniel F. Hayes, MD, FASCO, FACP. “Payer policies must reflect the current requirements of contemporary cancer care and be evidence-based on what constitutes high-quality care.”
The new policy statement provides the following recommendations:
The policy statment recommends following ASCO’s criteria, “which promote patient protections for clinical pathway development, implementation and use, and analytics.”