The key in making coverage decisions about the integration of immuno-oncology agents into payment plans is being able to identify the patients who are most likely to benefit while also considering the long-term need for the acceptance of innovation in cancer care when faced with economic constraints, said Michael Kolodziej, MD, national medical director for oncology strategy at Aetna.
The key in making coverage decisions about the integration of immuno-oncology agents into payment plans is being able to identify the patients who are most likely to benefit while also considering the long-term need for the acceptance of innovation when faced with economic constraints, said Michael Kolodziej, MD, former national medical director for oncology strategy at Aetna.
Transcript (slightly modified)
How does Aetna expect to integrate the new immuno-oncology agents into payment programs and pathways?
So there’s kind of 2 separate parts here. One part is about immuno-oncology and the promise that immuno-oncology offers. And so like every other covered benefit, we have a certain set of rules that we will be forced to really employ as we make coverage decisions. As an oncologist, they’re tremendously exciting drugs.
I think the potential will only fully be tapped by the ability to identify patients most likely to benefit. And so I say this all the time: we are in such desperate need for the development of biological markers to predict response or, alternatively, to predict a lack of response because lack of response is important. It identifies patients with toxicity cost, financial cost, and opportunity cost. I think we’re going to manage them, at least in the short term, like we manage everything else.
I think in the long term, the question is more about innovation and how we accomplish the acceptance and dissemination of innovation in cancer care when we’re faced with economic constraints, the reality of the increasing cost of care, and although I don’t have the answer to that question right now, we need to keep a couple things in mind.
One, is we that we need to have intellectual honesty and not hype. I am completely aware of the desperation that patients with cancer find themselves. I totally get it. I think our job is to try to get the patient the right treatment and the best outcome, and worry about the cost in the context of really targeting that therapy to the right population, personalizing the care for that population. It gets a lot easier to consider the budgetary impact of an expensive immuno-oncology drug if 70% of patients are not going to benefit, if you’re not treating those patients, right? It does no patient good to receive therapy that is ultimately going to be ineffective and no patient is interested in receiving therapy that’s ineffective. So that should be a nice common ground where we find ourselves.
Ultimately, we are going to have to face the challenges with the cost of innovation, and what’s the fair cost of innovation, and how we pay for that, but we have some low-hanging fruit that we can tackle first.