Archbow Consulting recently had the opportunity to collaborate with national cancer leaders at the Association of Value-Based Cancer Care (AVBCC) Summit in New York City. The diversity of attendees - payers, pharma, HCPs, pharmacies, distributors, regulators, and employers – raised the bar on the conversation around the future of oncology and what it means for all of us.
In addition to moderating three panel discussions and participating in another, we attended fascinating sessions that explored what the future of cancer care should be vs. the reality of where it’s actually headed, and how we can each influence that trajectory within our own roles.
10 Takeaways from the 2018 AVBCC Summit
1. Cost, pricing, and reimbursement for oncology are more important than ever. There is a collective urgency to address the financial aspect of the disease sooner than later. Mark Fendrick, M.D., from the Center for Value Based Insurance Design, summed it up when he noted that, “Patients don’t care about the cost of cancer; they care about what it costs them.”
2. Consolidation by payers and providers is more about buying power and less about synergies. Long story short: the benefits to patients are slim while these organizations grow to be too big to fail.
3. Oncologists have different needs than other specialties when it comes to patient support services (HUBs), and that can lead to common mistakes in program design:
Failure to properly prioritize the HUB's true customer. Is it the patient or the prescriber? Either way, it’s vital to be aligned on that before building the program.
Lack of proper training for the sales team. Oncology practices need to be educated on programs to incorporate them into their workflow, and sales reps need the confidence to offer guidance, answer questions, and support busy office staff.
Shortsightedness in program design that fails to plan beyond launch and allow for the flexibility to adjust over time. Programs should be reviewed immediately after launch to understand what did and didn’t work. The marketplace is evolving rapidly, and today’s programs need to flexible enough to evolve simultaneously.
Failure to account for oncology experience in program design and development. The nuances in oncology matter and direct service provider experience and success with an oncology program can make or break how patient support is delivered for a brand.
Not thinking about patient support programs holistically. Quality cancer care should be simple and seamless to the patient and prescriber.
Sumner Madden, AstraZeneca, Douglas Bock, Archbow Consulting, Michael Fitzgibbons, ClaritasRx, and Tara Herington, Sonexus/Cardinal Health participated in a panel discussion on Optimizing Patient Services: Solutions in Cancer Care.
4. There’s still a lot to figure out about value-based contracting, but it’s real, it’s happening today, and it’s something we all need to embrace. As many as 30% of payers are already currently experimenting with VBC and just about everyone is open to a solution. While VBC in oncology offers unique challenges (is value defined as months of survival or a cure?), more entities are considering this option.
5. Being a medical oncologist isn’t as easy as it used to be. In the wake of 340B-driven hospital-practice consolidation, they’re swimming upstream against administrative burden, declining revenues, and less control of how they care for patients. Prior authorizations continue to be one of the largest pain points, with one physician after another complaining about hours wasted on hold with payers.
6. A strategic approach to supply chain design is vital to brand success, but that design may be more convoluted than ever. Experts in supply chain identified the trends and disruptors that they’re watching closely:
CAR-T and other high-priced therapies are choosing limited distribution models based on limited options, not so much based on facilitating patient access.
Biosimilars are bringing competition to the top 10 oncology products and influencing future contracting. While adoption in the U.S. lags behind ROW, the biosimilar wave is approaching.
The “pros” of limited distribution (manufacturer control, better patient journey) are at times in direct conflict with the “cons” (HCP dissatisfaction, gaps in patient care.) That said, payers ultimately embrace the least expensive supply chain model.
Independent Delivery Networks (IDNs) as customers are growing in importance. Unfortunately, today they offer very few limited access products, are big black holes of information/data, and are still being restricted by payers in network design and ability to fill prescriptions.
The 340B conundrum and lack of data are two of the largest concerns for any manufacturer. GPOs can be great data partners, thanks to their integration with EMRs, but no one has a solution for controlling 340B abuse yet.
Kevin Cast led a panel discussion on the Oncology Supply Chain.
7. Copay accumulators are top of mind in oncology just like they are everywhere else. These aggressive management tactics were developed in response to employer requests to help manage and enforce high deductible benefit designs that are self-selected by the employee. The “solutions” being offered today, no matter what your favorite vendor is trying to sell you, are not enduring as they still result in an incremental spend by the pharma manufacturer. Read more on this hot topic here.
8. While historically the importance of the National Comprehensive Cancer Network (NCCN) guidelines have been downplayed, more and more PBMs, Payers, and HCPs are embracing these important evidence-based suggestions for therapeutic engagement.
9. There is a battle brewing between IDNs and payers regarding ownership of the patient. This question of who “owns” the patient is one that needs to be answered as IDN-owned specialty pharmacies seek access to limited distribution oncology drugs. Strong consideration needs to be given to 340B implications, payer restrictions, patient management, and data outputs.
10. The Administration’s “International Pricing Index” (IPI) has potentially frightening ramifications and raises a lot of questions. The new proposal aims to reduce reimbursement for medicines administered to seniors under the Part B benefit to an amount pegged to the average price paid in foreign industrial nations. In the industry, we’re all left wondering:
Could this really save Medicare and Medicaid $17 billion over its first five years?
What are the cascading ramifications for ROW as prices in the U.S. get lowered?
Would dropping prices then affect the ROW reference price?
Does pharma need to be proactive in discussing the IPI with the so-called “freeloaders” in ROW, or will this initiative fail to gain any traction?
We attend events like AVBCC because these issues are top of mind for our oncology clients and we’re better able to support them when we’re part of the ongoing conversation. When your brand needs experienced, knowledgeable oncology support, we’re here to help.
Kevin Cast and Douglas Bock