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Effectively run an oral oncology drug program
Regence BlueCross BlueShield of Oregon has been managing oral oncology drugs since 2005. “Our oral oncology management program is driven by rigorous evidence-based medication assessments that help ensure our members have access to medications that safely and effectively manage their conditions,” says Raulo Frear, general manager, OmedaRx, Regence’s pharmacy benefit management partner. Here they share some of their best practices.
Perform a thorough, evidence-based comparative assessment of your products. Have a pharmacy benefit manager critically appraise literature to fully understand the comparative health benefits of medication, and rely on an oncology subcommittee of the Pharmacy and Therapeutics Committee to gain further insight and analysis.
Implement a rigorous evidence-based utilization management system. Evidence-based formularies, coverage policies and prior authorization can help drive utilization toward proven therapies to promote safe and affordable care, and discourage unproven or excessive utilization.
Establish partnerships with best-practice specialty pharmacies. Specialty pharmacies offer tailored services to help ensure patients safely take and manage their medicine through partial fill dispensing, counseling and clinical support. Specialty pharmacies may also offer an alternate care site for provision of supportive therapies, such as pegfilgrastim.
Engage your members and help them make good decisions. A pharmacy benefit manager can provide members with informational summaries that describe how well cancer medications work and what the potential side effects are in clear and concise language.
Integrate the management of your medical and pharmacy benefits programs. Integration is crucial for a safe, efficient and innovative program. With more and more oral choices becoming available, there may be opportunities for payers to negotiate discounts for preferred products or preferred channel management across benefit designs.