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.”

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