Managed Care - April 2008 - (Page 28) Insurers and Oncologists Forge A Better Cancer Drug Policy The goal is to keep oncologists from relying on drug markups to keep their incomes high, but it’s slow going keen to have health plans limiting their options. The Zitter Group is a consulting company for pharmaceutical manufacturers. Its most recent survey included responses from 100 health plan meds the costs of treating cancer escalate, health ical and pharmacy directors and 126 oncologists, plans are putting new energy into manand documented continuing mistrust between the aging one of the most difficult categories two groups. of health care. The going is slow, “Honestly, it’s going to be a while before but major changes in the way oncology servthat story is rewritten,” says Nicole Dautel, ices are chosen — and paid for — are emergZitter’s associate director. ing. The tug of war, of course, is mostly about Although standard tools like prior authe money available to treat cancer, the secthorization dominate cancer management ond most common cause of death in the at the moment, health plans are experiUnited States. Health plans see the number menting with new ways of paying oncoloof plan members being treated for cancer ingists, with the goal of cutting treatment costs “What I pay the creasing steadily as the American population dramatically. oncologist” is not ages and cancer patients live longer with their Health plan executives think they pay for the problem, says disease. Meanwhile, the number of new treatmany treatments and services that do the pa- Lee N. Newcomer, ments is accelerating, along with their prices: tients no good and that 20 percent of cancer MD, of UnitedMost of the 400 new therapies in the pipeline care costs could be eliminated without hurt- Healthcare. Rising ing patients, according to the most recent costs have more to are expected to cost at least $50,000 a year. issue of the Zitter Group’s Managed Care do with “what they Helping oncologists to make more costdo with their pen.” Oncology Index. effective treatment decisions is impeded by the fact that oncologists and health plans see Oncologists agree that the costs of treatthe world differently. They do not even agree on ment are too high, but, not surprisingly, they are not By Lola Butcher Contributing Editor A Diverging views on plan’s role in cancer management Industry and oncologists don’t see eye to eye 4.42 3.29 4.11 3.44 3.90 2.71 3.83 Payers 3.23 Oncologists 3.92 2.81 “Physician drug revenue generating opportunities can create perverse incentives.” “Supportive care is an appropriate target for management by commercial payers.” “You could cut 20 percent of costs in cancer and have no discernible effect on outcomes.” “Enforcement of guideline and/or compendia-based prescribing rules can improve quality of cancer care.” “Oncology is too sensitive to be managed effectively by insurers.” Note: The scale runs from 1 (strong disagreement) to 5 (strong agreement). Source: Managed Care Oncology Index, Winter 2008. Zitter Group, based on survey of 100 health plans covering 105 million lives and 126 oncologists 28 MANAGED CARE / APRIL 2008
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