More evidence-based treatment sequencing must be put into practice to reduce the number of medications patients use on a trial-and-error basis
As a breadth of evidence and clinical guidelines for the treatment of multiple myeloma bump up against the introduction of promising new agents, payers face the challenge of providing sufficient coverage that meets the needs of a patient population while maintaining the ability to pay for it.
A multi-faceted, point/counterpoint symposium (SS1), “Control Versus Care,” highlighted payer and provider perspectives on treating multiple myeloma that reflected a desire by both groups to collaborate in the best interest of patients despite the range of treatment recommendations and emerging data.
The half-day session focused on the value proposition of drug sequences, treatment selection and duration of therapy, applying comparative-effectiveness research (CER) as a decision support tool to reduce treatment variability and collaborations to improve care of multiple myeloma patients.
“The prevailing atmosphere in the current management of hematologic malignancies is that payers generally maintain liberal coverage criteria, while allowing clinicians to make largely independent decisions based on the available data and unique patient characteristics,” says Steve Casebeer, executive vice president, Impact Education LLC, and moderator of the panel discussion.
Overtreatment seems to be one of the biggest challenges, as patients are prescribed myriad medications with the hope of finding the one that produces the best outcome. This emphasizes the importance of evidence-based treatment sequencing.
The panel examined varied clinical opinions about the most effective treatments for the condition based on perceptions of the relevance of emerging data and practice guidelines. Casebeer pointed out that the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines present an apparent dichotomy in therapeutic strategies.
Another challenge for MCOs highlighted at the meeting was the high cost of specialty drugs to treat multiple myeloma. Cancer drugs currently comprise eight out of the top 10 most expensive drugs covered by Medicare, according to the American Society of Clinical Oncology.
Although the disease is incurable, there are many innovative agents and stem cell transplant options to increase survival that raise the question of who would pay for treatment.
For example, pomalidomide-an oral drug for patients whose disease has progressed after being treated by other cancer drugs-costs $10,500 per cycle. Clinical trials indicate that most patients require five cycles of treatment. However, it could be covered under the pharmacy benefit, providing better utilization management for payers.
The same scenario will undoubtedly apply to MLN9708 (Millennium), an investigational proteasome inhibitor due out in 2014.
Clinical trials for multiple myeloma treatments often make fewer head-to-head comparisons and lack data illustrating “hard” endpoints. With less comprehensive trial data, managed care organizations must pay attention to experience data evaluating the comparative effectiveness and net costs.
The session provided step-by-step instructions and application examples to assist managed care professionals in implementing CER to effectively assess various treatments for multiple myeloma within their health plans.