Biotechnology Healthcare - June 2008 - (Page 48) To win marquee status on the “heavy radar screen,” as Mitchell calls it, a new product has to have two features: a big price tag and a good chance that physicians will want to use it for more than just the labeled indication. PharmD, SelectHealth’s director of pharmacy, assigned one pharmacist to the task. “It was, quite frankly, overwhelming,” Cannon says. “It became very apparent I could not just have one person focused on the entire area.” Today, injectable responsibilities are divided up among the health plan’s pharmacists. Mitchell, who has experience in hospital and community pharmacy, is the resident expert for oncology therapies, as well as treatments for diabetes and attention deficit hyperactivity disorder. Antipsychotics, antidepressants, and anti-infectives are other areas of expertise. Injectables, currently accounting for about half of his workload, will increasingly claim a larger portion of his daily decision making. A quick glance at the white board in his office reminds him of the products headed toward market that eventually may meet with some type of restriction: mifamurtide (Junovan), AE-941 (Neovastat), oblimersen sodium (Genasense), nilotinib (Tasigna), and eculizumab (Soliris). Scratch eculizumab. SelectHealth’s pharmacy and therapeutics committee recently required prior authorization (PA) of this monoclonal antibody for patients with paroxysmal nocturnal hemoglobinuria, a rare blood disorder. As few as 600 people in the United States may be appropriate candidates for the therapy, which costs about $390,000 a year. If only every PA decision was so easy…. To win marquee status on the “heavy radar screen,” as Mitchell calls it, a new product has to have two features: a big price tag and a good chance that physicians will want to use it for more than just the labeled indication. In other words, oblimersen. Believed to make chemotherapy twice as effective in killing cancer cells, this antisense drug was hyped a few years back as a godsend for almost any type of cancer and any chemotherapy routine. Since then, the FDA has repeatedly given it a thumbs-down — but Genta, its manufacturer, refuses to give up. Mitchell thinks oblimersen is headed to the market for at least one indication — and that 48 BIOTECHNOLOGY HEALTHCARE · MAY/JUNE 2008 every cancer patient who peruses Genta’s Web site will want to try it. Part of his responsibilities includes working with oncologists to develop guidelines and access criteria for new oncologic agents, and he’s thinking ahead to that day. But all in good time. Today, Mitchell’s immediate concern is maintaining good relations with oncologists while managing reimbursement methodologies, particularly for new, high-dollar biologic therapies. Like many health plans, SelectHealth is moving to a new strategy in which physicians who administer injectables will be paid on the basis of average sales price (plus an administration fee) rather than average wholesale price. CMS pioneered this strategy, and, increasingly, private health plans are warming to it. Some health plans expect this will reduce oncology expenses by 20 percent, in part by removing a profit center from oncologists. Are oncologists overpaid? Not for Mitchell to say. His big-picture goal is to maintain relationships with oncologists built on trust. “We benefit from not having animosity between the two parties — the oncologists and the health plan — so that they’re willing to accept restrictions on products,” he says. “They’re very upfront, and will say, ‘You know what, these products should be restricted’. By keeping communication open, we ultimately save money.” Mitchell is only marginally involved in negotiations for the new contracts, but he puts together data that help develop the new reimbursement schedule. He wants contracts that somehow maintain overall payment levels for oncologists, despite the new way in which they will be paid. “The goal is to not hurt the relationship,” he says. “Switching from AWP to ASP is a lot more difficult than we thought it would be.” PREPARING FOR WINTER Buckley found her way to SelectHealth after stints at both hospital and community pharmacies, along with a pharmacoeconomics research center. The health plan position offers a mix of pa-
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