Watch list 2016: Top therapeutic areas

This year, many new medications and treatments emerged to improve the management and prognoses of patients suffering from serious illnesses. But while these developments represent promise, they also raise complex decisions related to cost and quality. In 2016, as these developments play a larger role in health management and treatment, managed healthcare executives must be informed. Here's a quick look at some of the latest developments in top therapeutic areas that should be on your radar.

1. Oncology

As new, more tailored and effective oral treatments emerge, the oncology drug category will be one to watch. “These [new treatments] will replace traditional IV therapies that took a more ‘shotgun approach,’ by treating general cancer types,” says Steve Liles, PharmD, senior director, pharmacy services at Goold Health Systems, an Emdeon Company.

“This year, at least 10 to 15 new medications targeting specific cancers have been approved, and I expect that trend to continue,” he says. “This growth is led largely by the immuno-oncologics-effective, well-tolerated agents for which there is and will continue to be increasing use, often in combination regimens, for solid tumors.” 

Goldberg

Robert Goldberg, PhD, vice president and cofounder, Center for Medicine in the Public Interest, agrees. Managed care executives should look to the new immunotherapy treatments such as Opdivo and Keytruda, both for advanced melanoma, Goldberg says. “There are dozens of such therapies that all target specific immune factors that can be taught to stop tumors from spreading. They most often will be used in combination with other treatments customized to individual patients.” 

Heather Morel, vice president and general manager of Health Informatics, Reimbursement, Access and Safety Services for McKesson Specialty Health, says this therapeutic category of drugs, which is now being applied to treat metastatic melanoma and non-small cell lung cancer, is very promising.

Morel

“In some patients we are seeing durable benefits and long-term survival in diseases where the survival rates have been abysmal,” Morel says. “The hope and promise of these drugs is that we will learn the best ways to use them, whether that is in combination with other checkpoint inhibitors, with targeted therapy, chemotherapy, or as stand-alone therapy. There are a number of significant drug development programs targeting many of the major tumor types, and over the next few years we should see new agents enter the market and literature grow.”Liles says new oncology therapies will impact managed care organizations in several ways, including:

 

 

Helping them find the right treatment-faster. “The more targeted therapy will allow facilities to pinpoint the exact type of medication that will work for patients, cutting down on the waste associated with broader medication therapies,” he says. “Treatments can be identified more quickly, saving time and money for everyone involved. Moreover, it’s a lot easier for the physician to justify putting a patient on this type of therapy as it is better tolerated than traditional cancer treatment.”

Turning cancer treatment into chronic disease management. “Patients are receiving these new types of therapies over longer courses of time, in part because they are much more effective,” Liles explains. This will be a paradigm shift for managed care organizations. As patients respond better, oncology will shift from short-term and acute treatment to longer-term chronic disease management, he says. “In many ways, this shift will mirror the evolution of HIV treatments. In the early years, patients were given handfuls of drugs that blanket-treated the disease, had severe side effects and didn’t effectively work. Now, patients with HIV receive more specific drugs over a longer period of time; many are living without side effects and have good prognoses.”

Raising difficult cost discussions. These new oncology drugs are expensive, so everyone-including MCOs, employers, providers and patients-will have to weigh the cost of these therapies against the long-term benefits, says Liles.

“Having more choices and better access to data around therapies is great, but this means MCOs will have some tough decisions when selecting the medications that work best for their formularies,” he says. “Drug costs will always be increasing. So, MCOs will have to continue assessing medication spend against the overall percentage of medical costs and the opportunity cost of preventing possible downstream cost increases. At the end of the day, many will have to make an economic analysis of their options, which could be difficult to do.”

 The cost of new medicines, used in combination, could be as much as $100,000 or more for a course of treatment “but the value will be immense,” says Goldberg. “We are seeing significant gains in survival and a reduction in hospitalizations. To really support formulary managers, those benefits and savings should be factored into the determination of what these medicines are worth to the healthcare system, beyond just the cost of the drugs.”  

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