Panel Discussion

Expanding the definition of "value" beyond cost, Robert Dubois, MD, PhD, emphasized that clinical pathways need more dynamic quality metrics that provide more than just a snapshot of a patient's performance.

Panelists discussed whether there is any flexibility woven into the process of developing a clinical pathway, especially if a patient does not respond to a particular therapy or if a clinician wants to include a new therapy that may be better fit.

While providers would be relieved of their administrative burden, standardizing care pathways across health plans may not be an easy task, Blase Polite, MD, MPP, explains.

Have clinical pathways in oncology developed enough for providers and patients to use them as a shared decision-making tool? Panelists provide insight.

Experts discuss the need for guidelines and adequate rigor when developing a care pathway in oncology.

What do pathway developers consider as they formulate cancer clinical pathways? Panelists explain.

Panel members provide their own perspective on what clinical pathways encompass.

The American Journal of Managed Care convened an expert panel to discuss the development and utility of clinical pathways in oncology care.

Looking at the situation in hepatitis C and its potential impact on other conditions from a provider standpoint, Ed Cohen, PharmD, FAPhA, offers up many questions to which there may not be answers just yet.

The situation with hepatitis C drug costs is setting an interesting precedent for the rest of healthcare and one that needs to be watched closely, according to Keith Hoffman, PhD.

Although the marketplace has managed to come to a temporary solution for the high cost of hepatitis C drugs, Steven Miller, MD, MBA, expects to see more examples of similar high-cost drugs in other categories.

In the last year the hepatitis C drug market has gained a lot of attention in the healthcare industry despite the fact that oncology as a specialty drug market has been very expensive for years now.

The idea has been floated that the government should try buying the patent rights for Harvoni from Gilead Sciences in an attempt to improve access, but even if such a move was feasible, no one seems to think it's a good idea.

Although the Adverse Events report found Viekira Pak may not be as safe as Sovaldi and Harvoni, Express Scripts complimented that information with its own real-world data from 85 million patients before choosing Viekira Pak.

A recent report from Adverse Events suggests that based on the pre-approval adverse events listed for Viekira Pak that Harvoni and Sovaldi may be safer, according to Keith Hoffman, Phd.

Even with 2 drugs competing with one another and more coming soon, Ed Cohen, PharmD, FAPhA, does not believe additional competition in the marketplace will significantly drive down costs for a hepatitis C cure.

The panelists discuss potential adherence issues considering Harvoni is a once daily pill while Viekira Pak is a 2-pill combination. Steven Miller, MD, MBA, explained that at 84 days, the treatment period is relatively short no matter what, which makes adherence less of an issue.

Harvoni has shown results within the first 8 weeks of treatment, which would save costs, Matthew D. Harman, PharmD, MPH, does not think many patients or providers will be making cost-based hepatitis C treatment decisions.

After Viekira Pak was approved, Express Scripts kicked off a spree of exclusivity deals with pharmacy benefit managers and health plans picking Harvoni or Viekira Pak. Steven Miller, MD, MBA, estimates this will save the US market $4 billion in 2015.

While formularies should provide physicians the ability to treat any patient that walks into the office, there also need to be clinical exceptions that allow patients with mitigating circumstances to get any product clinically necessary.

The panelists discuss the evidence that is weighed when determining whether or not to include a particular therapy on their regimens.

Payers differentiate between predictive and prognostic diagnostic tests, and one is definitely more useful than the other, according to John L. Fox, MD, MHA, of Priority Health, and Bryan Loy, MD, MBA, of Humana.

Using diagnostic tests thoughtfully becomes more difficult when demand is being driven by laboratories marketing the tests and patients who say they want the test, according to Francisco J. Esteva, MD, PhD, and Bryan Loy, MD, MBA.

The panelists share their thoughts on the future of diagnostic tests and what changes they are looking forward to, such as developing better systems to integrate clinical information with molecular data and increased FDA oversight.

Daniel F. Hayes, MD, outlines the 2 paradigms presented in medical oncology: one where people would rather be overtreated rather than miss a chance to benefit by being undertreated and another where a person might not be willing to do something until they learn there is a reason to do so.

There is an important distinction between diagnostic and screening tests, and they have different issues in regards to decision making-although the person making treatment decisions should ultimately be guiding the ship, according to Bryan Loy, MD, MBA.

Both Francisco J. Esteva, MD, PhD, and Daniel F. Hayes, MD, agree that the role of genetic counselors should be limited when order diagnostic tests in medical oncology.

When tests with clinical utility haven't made it onto the guidelines yet, what should payers do?

The panelists discuss guidelines for diagnostic test use and the biggest challenge from a payer standpoint.

Daniel Hayes, MD, explains the implementation of the American Society of Clinical Oncology's CancerLinQ for beta testing.