Biotechnology Healthcare - June 2008 - (Page 49) tient and physician contact, data analysis, and members understand what they are getting into population management that suits her, even before we actually start the process,” she says. The committee does not make any changes to though juggling multiple perspectives can be the PA criteria for palivizumab at today’s meetchallenging. On this day after Labor Day, it is 93 degrees ing, but Buckley expects the subject to resurface in Salt Lake City, but Buckley is already think- at a future meeting. ing about winter. More accurately, she’s thinking about last year’s respiratory syncytial virus (RSV) THE DAY’S TAKEAWAYS Indeed, the only certainties of biologics are season — and whether SelectHealth’s strategy for managing palivizumab (Synagis) was effective. that new information will become available and Should changes be made for the coming season, new decisions will need to be made. and what data would be used to help decide? As for today, did Mitchell or Buckley take any RSV will likely hit Utah in November, but steps that will alienate physicians? Save or cost Buckley has already received her first authoriza- a lot of money? Help plan members or throw bartion request for palivizumab. By the time cold riers at them? Extend or limit someone’s life? weather hits, she’ll field several requests a day. Lots of nervous parents want the monoclonal antibody — considered preventive — in order to spare their children from the potentially severe illness. At least they think they want it. SelectHealth approved 245 requests for the shots last year, and denied 140 more — over 35 percent — because the children did not meet the PA criteria. Palivizumab is to be given in a five-shot series, with injections stretched over the winter. But fewer than half of the children approved received five shots; indeed, roughly 10 percent of those Matthew Mitchell, PharmD, MBA, MHP, is SelectHealth’s resident approved received no injections, expert for oncology therapies, ESAs, and other high-cost products. and 30 percent received just one or two shots. The immediate ramifications of today’s work When Buckley presents the numbers at the in- are difficult to foresee. What is easier to know is jectables committee, her colleagues want to know that, as more biologics become available, the even more: Did any of the approved children decisions are going to get more complicated. who were not vaccinated end up in the hospital? At the moment, physicians and patients have Did children who got just one or two injections great influence on most biologic decisions, parreceive any benefit? Did children born late in the ticularly for the many new therapies that are beRSV season explain the missed injections? coming available for cancer. Palivizumab costs about $1,000 per dose, and “It is so tough to associate cost-effectiveness Buckley suspects that coinsurance requirements with the treatment of cancer,” Mitchell says. prompt some parents to forgo the shots. “You cannot put a cost on a month of life — or “If we are going to invest the money into this two weeks. It is really hard for the health plan to very expensive treatment, we need to make sure put restrictions on coverage.” MAY/JUNE 2008 · BIOTECHNOLOGY HEALTHCARE 49
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