Three ways to maximize value in cancer treatment

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.

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