Insurers benefit from getting on board with Cancer MoonShot 2020

SenderHealth insurers can play a significant role in the Cancer MoonShot 2020 program, a historic national coalition formed to accelerate next-generation immunotherapy in cancer. “Managed care companies may find the cancer space scary because pharma prices are rising quickly and it’s difficult to determine which drugs will actually work,” says Leonard Sender, MD, medical director, Hyundai Cancer Institute at Children’s Hospital Orange County, Orange, California, and codirector of the Chan Soon-Shiong Institute of Molecular Medicine in Culver City, California. “But now, by using NantHealth’s novel GPS Cancer test, which provides a more rational, science-based approach, we will start to provide the types of tools that allow managed care providers to better understand what drugs should be used to treat cancer patients. This will result in less-expensive care in the long-term.”

Treating cancer patients with medicines that won’t work is occurring much too frequently. For example, data has emerged showing that HER2, a new test to detect breast cancer, often has incorrect results. Consequently, patients with a false positive result have been given extremely expensive drugs and patients that were falsely negative were not given life-saving drugs, Sender says.

“Although a physician wouldn’t prescribe an antibiotic to a patient with a bacterial infection if they knew it wouldn’t work, this has been done with cancer medicine,” he says. “But with the GPS Cancer test, which employs next-generation whole genome sequencing and proteomic testing, physicians can now know that a particular drug will not work, although they still may not know which drugs will work for sure. This becomes more important as expensive checkpoint inhibitors become commonplace, but is found effective in only 10% of patients. With the GPS Cancer test we may be able to predict which patient would benefit and which would not.”

“We think it’s a win-win program for patients, providers, and health insurers,” Sender says. “Our goal is to cure many patients with treatments that are less toxic at reduced costs. The fact is, if we don’t proceed in this manner, the healthcare industry may become unsustainable.”

How it works

LeeWhen health insurers partner with Cancer MoonShot 2020, drugs will be provided to their members on clinical trials free of charge. “Insurers will still be responsible to pay for GPS testing, delivering the cost of care, and part of the cost of clinical trials [which are also funded by pharma companies],” Sender explains. “In the long-run, it is in a managed care company’s best interest for patients to be treated with appropriate imaging, therapies, and drugs.”

John Lee, MD, cancer center director, Chan Soon-Shiong Institute of Molecular Medicine, and surgical oncologist at Sanford Health in Sioux Falls, South Dakota, says his institution chose to offer GPS testing because, “We felt that the informatics and depth of coverage of DNA sequencing offered the best testing option available. In addition, our health insurer decided to cover this testing because by gleaning knowledge from the GPS test, we will be able to save a significant amount of money because some drugs cost hundreds of thousands of dollars.”

“This is a value-added test from the perspective of cost savings,” Lee continues. "What is exciting is that more insurance companies are getting on board since the launch of this test just a few months ago.”

Next: First insurer on deck

First insurer on deck

When multinational pharmaceutical, biotechnology companies, academic centers, and community oncologists joined together to form Cancer MoonShot 2020, The National Immunotherapy Coalition-a collaboration with Independence Blue Cross, Philadelphia, Pennsylvania, one of the nation’s largest payers, and Bank of America, one of the country’s largest self-insured companies, also formed. Their singular focus is to accelerate the potential of combination immunotherapies as the next-generation standard of care in oncology patients.

ColettaIndependence Blue Cross became the first major insurer to offer access to GPS Cancer testing in March 2016, after entering into an agreement with Culver City, California-based NantHealth in January 2016.

“Whole genome sequencing fully sequences thousands of genes in a single test, detecting DNA mutations that may serve as markers that inform decisions about optimal cancer therapy,” says Anthony V. Coletta, MD, MBA, executive vice president and president, Facilitated Health Networks, Independence Blue Cross. “The science around genomics and immunotherapy and their potential to advance cancer care is evolving. Making the GPS Cancer test available is one way that Independence is responsibly contributing to the development of the evidence base and potentially helping to advance cancer care.”

“Coverage of GPS Cancer by Independence Blue Cross enables us to begin the process of generating patient-specific clinical information that will improve the evidence base on which providers determine their treatment decisions,” says Patrick Soon-Shiong, MD, founder and chief executive officer of Culver City, California-based NantWorks and founder of the Chan Soon-Shiong Institute of Molecular Medicine. “We are thrilled to have them on board as we strive to catalyze change in cancer care by offering oncologists the most comprehensive molecular insights available.”

Soon-ShiongThe test will be covered for insured members with specific conditions including rare cancers, tumors in children, metastatic cancer of unknown primary brain cancer, triple negative breast cancer, and metastatic cancer when conventional therapies have been exhausted and patients remain candidates for further therapy, including immunotherapy.

The GPS Cancer test includes a Web-based clinical report that provides actionable patient-specific clinical information for physicians and patients at the point of care. Earlier this year NantHealth, which already offers the eviti oncology decision support software, added NaviNet Open, a payer-provider collaboration platform.

The eviti clinical decision support platform facilitates determination of evidence-based protocols based on the molecular and clinical stage of a patient's cancer. The NaviNet Open payer-provider collaboration platform enables doctors and payers to review information in real time. Together, the NantHealth operating system serves as a scalable, real-time access point and portal for providers and patients to receive scientific, clinical, and other information about novel therapies and relevant clinical trials, all based on the results from a patient’s GPS Cancer test.

Next: Encouraging others to join

Encouraging others to join

“Insurers have an obligation to engage in responsible efforts to advance cancer care and to encourage innovative approaches,” Coletta says. “Our goal is to support our members and their oncologists in accessing the best care and helping our customers continue to be able to afford coverage. By offering access to GPS Cancer, we are giving our members one more option to help inform a personalized, effective cancer treatment plan. Rapid advances in molecular biology and genetics may require healthcare executives to fundamentally rethink the way we determine whether a given service is considered effective-so we are responsibly promoting the adoption of more effective therapies.”

“Support from leading insurance companies as well as self-insured employers are crucial in order to provide coverage for whole genome sequencing and proteomic testing. These payers will ensure medical policy is in place to support patients having access to leading edge science,” says Soon-Shiong. “The launch of GPS Cancer, together with coverage by a major payer serving with their affiliates 10 million people in 34 states, combined with the introduction of a collaboration and clinical decision support portal providing access to more than 450,000 healthcare professionals for real-time communications and access to ground-breaking clinical trials, and a multi-payer portal for more than 100 million covered lives, collectively creates a healthcare collaboration network at a national scale. We believe this platform will provide more personalized and cost-effective treatment options for patients with cancer.”

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.