Managed Care - July 2008 - (Page HCover2) WELCOME INTRODUCTION Care Editor JOHN MARCILLE Managing Editor FRANK DIAMOND Associate Editor TONY BERBERABE Design Director PHILIP DENLINGER MediMedia Managed Markets Publishing Editor, Custom Publications MICHAEL D. DALZELL Senior Editors, Custom Publications KATHERINE T. ADAMS AMY KRAJACIC Contributing editors to this supplement SCHUYLER MATTHEWS SUSAN L. WORLEY Group Publisher TIMOTHY P. SEARCH, RPH Director of New Product Development TIMOTHY J. STEZZI Eastern Sales Manager SCOTT MACDONALD Senior Account Manager KENNETH D. WATKINS, III Director, Production Services WANETA PEART Circulation Manager JACQUELYN OTT MANAGED CARE (ISSN 1062-3388) is published monthly by MediMedia USA, 780 Township Line Road, Yardley, PA 19067. This is Supplement 6 to Vol. 17, No. 7. Periodicals postage paid at Morrisville, Pa., and additional mailing offices. POSTMASTER: Send address changes to MANAGED CARE, 780 Township Line Road, Yardley, PA 19067. Price: $10 per copy, $100 per year in the United States; $120 per year elsewhere. E-mail: editors_mail@managedcaremag. com. Phone: (267) 685-2788. Copyright 2008, MediMedia USA. M A N A G E D Managed Care Considerations: Hematologic Cancer as a Chronic Disease RONNIE J. DEPUE, RPH Corporate Clinical Pharmacy Director, Coventry Health Care, Glen Allen, Va. W www.managedcaremag.com ith the development of targeted therapeutics and other novel treatments, the oncology landscape has changed enormously. Perhaps some of the greatest changes have taken place in the realm of the hematologic cancers. Less than a decade ago, patients diagnosed with diseases such as myeloma or one of the myelodysplastic syndromes (MDS) received a rather grim prognosis. Today, with the availability of multiple therapeutic regimens, patients with these disorders are living longer. In fact, many hematologic cancers are now perceived as chronic diseases – and this development has certainly gotten the attention of managed care. A vast number of agents from existing and novel therapeutic categories have shown promise in improving survival rates compared with previously available agents. However, these newer agents are likely to be associated with higher treatment costs, more complicated administration, and the need for increased patient monitoring and education. Appropriate analyses are necessary to determine the place of these therapies in managed care. Because many of the newer agents are categorized as specialty pharmaceuticals and are covered by both medical and pharmaceutical benefits, MCOs have a unique opportunity to make improvements across the whole spectrum of care. At the same time, however, there is an industrywide need to shift from a medical style of management to a more rigorous pharmacy style of utilization management. This management style brings safety, efficacy, and cost into sharper focus to develop the best coverage policies possible for the appropriate use of new agents. Considerations that play a role in utilization management include U.S. Food and Drug Administration-approved indication(s), along with recognition in the compendia and treatment guidelines. Data from the outcomes and safety profiles of different regimens, and determinations of whether agents are more appropriately used in a first- or a second-line setting also are invaluable. Another significant issue — patient compliance — can be affected by a number of variables that distinguish different therapies, including side effects, route of administration, and the level of beneficiary cost sharing. Finally, issues of cost reduction will remain at the forefront. In general, the goals are to start patients on the appropriate therapy, ensure compliance, and when appropriate, aim for remission. In the following pages, a distinguished panel of experts reports on hematologic cancers, as well Medicare policies relevant to their management. Steven Coutré, MD, reviews MDS, Joseph M. Tuscano, MD, presents an overview of multiple myeloma, and Richard Stefanacci, DO, provides recent updates on related Medicare policies. Disclosure: Ronnie J. DePue, RPh, reports no real or apparent conflicts of interest with respect to companies or other organizations or proprietary products mentioned in this article. http://www.managedcaremag.com
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