IVBM All Coverage

With multiple biosimilars approved for a reference product and different payers preferring particular products, communication between the clinical pharmacy team and the managed care team is crucial, said Timothy Murphy, MD, FACP, medical oncologist/hematologist with Rocky Mountain Cancer Centers.

Ishani Ganguli, MD, MPH, assistant professor of medicine at Harvard Medical School, physician at Brigham and Women’s Hospital, reacts to receiving the 2022 Seema S. Sonnad Emerging Leader in Managed Care Research Award.

Population health brings an important lens to both oncology practice and research, said Neil Iyengar, MD, associate attending physician, breast medical service, Memorial Sloan Kettering Cancer Center.

Having a plan in place to educate providers and the pharmacy team has contributed to the success that Rocky Mountain Cancer Centers (RMCC) has had with rapidly implementing biosimilars, said Timothy Murphy, MD, medical oncologist/hematologist with RMCC.

Coverage from the New York City presentation of the Institute for Value-Based Medicine, co-chaired by Emeline Aviki, MD, MBA, of Memorial Sloan Kettering Cancer Center (MSKCC), and Robert Daly, MD, MBA, medical oncologist and lung cancer specialist at MSKCC.

A featured presentation at the Irvine, California, meeting of the Institute for Value-Based Medicine discussed how a patient with long-term HIV was cured through a transplant.

Coverage from the Irvine, California, meeting of the Institute for Value-Based Medicine, chaired by Joseph Alvarnas, MD, vice president for government affairs at City of Hope and chief clinical advisor, AccessHope.

Coverage from the Minnesota meeting of the Institute for Value-Based Medicine, chaired by Rajini Katipamula-Malisetti, MD, vice president of medical oncology at Minnesota Oncology.

Coverage from the Atlanta meeting of the Institute for Value-Based Medicine, chaired by Ryan Haumschild, PharmD, MS, MBA, director of pharmacy services, Emory Healthcare and Emory Winship Cancer Institute.

Biosimilars have had such an impact on driving down costs, that in some instances the reference product might be the lowest cost option, explained Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Even though there is a 1-year gap between the Oncology Care Model and the Enhancing Oncology Model, there remain value-based oncology payment programs with private payers, said Glenn Balasky, executive director of Rocky Mountain Cancer Centers.

With more and more biosimilars reaching market, there are considerations around whether to keep patients on their current biosimilar or switch them to another biosimilar as the market dictates, said Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Lung cancer screening rates remain low nationwide, and there is a need to better educate patients and clinicians about the importance of screening, said Ticiana Leal, MD, associate professor, director of the Thoracic Medical Oncology Program, Department of Hematology and Medical Oncology, Emory University School of Medicine.

With multiple pathways and stakeholders involved, there needs to be an arbiter who decides what is the highest quality and highest value care in oncology, said Lucy Langer, MD, MSHS, national medical director, oncology and genomics, UnitedHealthcare.

The Enhancing Oncology Model (EOM) will be the successor to the Oncology Care Model.

Co-hosted by Memorial Sloan Kettering Cancer Center, the most recent Institute for Value-Based Medicine® event took place on September 22, with a focus on improving cancer care delivery through innovation.

Targeted therapies have improved outcomes for patients with lung cancer, but the goal needs to be tailoring the right therapy to the right patient, said Ticiana Leal, MD, associate professor, director of the Thoracic Medical Oncology Program, Department of Hematology and Medical Oncology, Emory University School of Medicine.

When converting a patient to a biosimilar, having clear and consistent messaging will reduce confusion and prevent patients from having a lack of trust in the process, said Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Being able to use minimal residual disease (MRD) negativity to make treatment decisions, such as stopping maintenance therapy, can have savings related to cost and quality of life (QOL) for patients, said Ajay Nooka, MD, MPH, FACP, associate professor, Winship Cancer Institute.

Biomarker testing should be done on all patients with an initial diagnosis of advanced nonsquamous non–small cell lung cancer, but the testing rates in the real world are lower than they should be, particularly for underserved or minority populations, said Ticiana Leal, MD, associate professor, director of the Thoracic Medical Oncology Program, Department of Hematology and Medical Oncology, Emory University School of Medicine.

While commercial payers have been engaged with the shift to biosimilars, they all have their own preferred biosimilar, which makes it challenging for practices, explained Lalan Wilfong, MD, vice president of payer relations & practice transformation at The US Oncology Network.

Everyone agrees that minimal residual disease (MRD) is the best prognostic tool for multiple myeloma, but there is disagreement on how to use the MRD results, said Ajay Nooka, MD, MPH, FACP, associate professor, Winship Cancer Institute.

While initially there was a need for education around biosimilars, now there is a need to keep an eye on the evolving biosimilar marketplace and update the formulary of biosimilar medicines, said Paul Forsberg, PharmD, director of pharmacy, Minnesota Oncology.

Minimal residual disease (MRD) testing is used to understand the depth of response, but currently the data at Emory are not used to make treatment decisions, said Ajay Nooka, MD, MPH, FACP, associate professor, Winship Cancer Institute.

The 1-year gap after the end of the Oncology Care Model (OCM) means some practices have to make hard decisions regarding cost of care or the financial health of the practice, explained Lalan Wilfong, MD, vice president of Payer Relations & Practice Transformation at The US Oncology Network.

While the Community Oncology Alliance (COA) was involved in humanitarian work in Puerto Rico after Hurricane Maria, the crisis in Ukraine caused COA to set up a special committee to jump into action, said Ted Okon, MBA, executive director, COA.

On this episode of Managed Care Cast, Ryan Haumschild, PharmD, MS, MBA, from Emory Healthcare and the Winship Cancer Institute, explains the evolution of biosimilar pharmacoeconomics and the different strategies that health care institutions can implement to reap the benefits of biosimilar savings.

Results from DESTINY-Lung01 have shown promising progression-free survival and overall survival with ongoing research that may lead to a future FDA approval in non–small cell lung cancer (NSCLC), said Ticiana Leal, MD, associate professor, director of the Thoracic Medical Oncology Program, Department of Hematology and Medical Oncology, Emory University School of Medicine.

The Institute for Value-Based Medicine series visits Texas Oncology in Austin.

Despite the Hospital Transparency Rule being in effect, the majority of 340B hospitals are not reporting their prices for top services and drugs, and those that have, reported on “egregious” markups, said Ted Okon, MBA, executive director, Community Oncology Alliance.