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Advancements in treatment show cancer trending towards a chronic condition. Align your cancer chronic care management team now. Here’s how. Advancements in treatment show cancer trending towards a chronic condition. Align your cancer chronic care management team now. Here's how.
Advancements in cancer care and therapies indicate it is on track to become a chronic condition. According to a study published in the Journal of the American Medical Association, “For men and women ages 50 to 64, who were diagnosed in 2005 to 2009 with a variety of cancer types, the risk of dying from those cancers within five years of diagnosis was 39% to 68% lower than it was for people of the same age diagnosed in 1990 to 1994.”
Oncology patients on new immunotherapies demonstrate survival rates in the three- to five-year range and average a 30% remission rate. However, little is certain about how long patients need to stay on those therapies, which is a major concern for payers.The growth in development of immunotherapy drugs for cancer treatment is also significant. According the cover story in the April 4, 2016 edition of Time, there are currently 3,400 ongoing immunotherapy trials ongoing in the United States.
Many industry experts believe the future of oncology drugs is infused immunotherapeutics. However oral oncolytics represent about 50% of oncology drugs currently in use and about 25% of drugs in the pipeline. An industry colleague with a large pharmaceutical manufacturer told me it is only a matter of time before oral immunotherapeutics enter the market. But like a large number of specialty medication therapies, adherence rates are frustratingly low.
Overall adherence to oral oncolytics is in the neighborhood of 50%. There is evidence that suggests for some groups adherence rates are much, much lower. What will this mean for managed care executives when oral immunotherapeutics enter the market and cancer treatment trends toward current treatments for chronic conditions including infectious diseases such as HIV or hepatitis C?
A slew of pharmacist-dispensed, oral combination therapies will enter the formulary while the industry works steadily toward a one-pill-per-day treatment. If adherence remains in the 20% to 50% realm, payers and PBMs should anticipate a spike in the $100 to $300 billion in wasted healthcare spending because of medication nonadherence.
As with any chronic condition, the goals for advanced oncology therapies should be improving outcomes, containing costs and increasing adherence rates. A holistic approach to chronic care management with clinical pharmacists playing a larger role within the care team is required. As we have seen through studies for patients with chronic conditions such as HIV and hepatitis C, enhanced medication therapy management protocols led by clinical pharmacists with robust patient support services achieve these value-based goals. For payers seeking the greatest value for all stakeholders as cancer migrates to a chronic condition, there are three key actions that you should take.
1. Align all parties early. We missed the boat on this with hepatitis C. Because payers, manufacturers and providers stubbornly remained isolated within their own silos, collectively we are mired in a battle between curing hepatitis C, providing critical access to drugs for patients who need them most, payer’s plan sponsors who need to keep costs low and manufacturers who are ultimately responsible to their shareholders, and most importantly patients stuck in reauthorization processes mid-therapy after having received initial approval.
As oral oncolytics and immunotherapeutics proliferate, payers, manufacturers, prescribers and pharmacists should be gathering around the same table right now to determine access points, prior authorization and reauthorization requirements and processes, pricing and outcomes metrics, especially in advance of oral immunotherapeutics’ arrival on market.
2. Build or leverage existing patient education and counseling programs. This phrase commonly describes adherence support as our team knows it. Continuity of patients’ contacts is critical to the value derivation of medication therapies for any chronic condition. Dedicated patient care coordinators who speak with the same patient on a week-by-week or month-by-month basis nurture trusting relationships. Data generated by these interventions, especially relating to barriers to adherence, positively influences adherence and outcomes for chronically ill patients. Are your pharmacists or pharmacist partners meeting the minimum patient touch points required to positively impact adherence and outcomes?
3. Improve information sharing capabilities. Providers tell us patients frequently “start therapies when they want to and stop when they want to.” This won’t work. Adherence to medication protocols is paramount to their efficacy and value derivation. Physicians should be alerted when refills are requested and shipped. As “value-based” contracts for high cost therapies between payers and manufacturers mature and proliferate, agreement on outcomes metrics, acquisition of data points (including lab results) and sharing of information among all chronic care team members becomes critical. In order to derive the greatest value from treatment as cancer enters the chronic care realm, every member of the patient’s care team should have visibility into the factors that influence access, adherence and outcomes.
Marc O’Connor is chief operating officefor Curant Health. Curant Health treats patients nationwide through its patient support services.