Adding Drug Costs to the Clinical Support Equation

In an interview with Evidence-Based Oncology™ (EBO), Amy Valley, PharmD, vice president of clinical strategy and technology solutions, Cardinal Health Specialty Solutions, discusses the Decision Path, a clinical support tool designed to inform oncology providers about drug costs along with clinical information, all embedded into the electronic health record workflow. This transcript has been lightly edited for clarity.

EBO: Can you describe Cardinal Health’s Decision Path and explain how the technology works?

Valley: Decision Path is the latest addition to our Navista TS platform, which is designed to help oncology practices be successful at value-based care.

I think everyone is acutely aware that the oncology care model is ending, which has been the CMS’ demonstration model over the past 6 years.¹ We don’t know exactly what’s coming next, but we’re certain that there will be successor programs.

In the meantime, many of our practices have gone on to develop their own types of value-based agreements and incentive programs with the commercial payers in their region. So even those practices that are waiting for what’s coming next in CMS are going forward and continuing to enhance their care coordination programs; they are making other investments in care transformation so that they can be successful as this journey from fee-for-service to value-based reimbursement continues.

EBO: How does the Decision Path make treatment evaluations easier for providers?

Valley: The Decision Path tool is very unique. It’s certainly not the first clinical decision support tool in oncology; there are several of these tools out there. Many tools, though, have a hindrance in terms of adoption or utility in that they require the provider to go into a separate program to navigate and select the treatment regimens. And providers are really, really keen on doing things within their current workflow whenever possible.

So one of the key aspects of Decision Path is that it is integrated into the clinical workflow. The second aspect, where we really focused heavily in our initial product launch, is the ability to pull financial information on the cost of the treatment regimens into that decision support tool. So Decision Path is unique in that it is right within the clinical workflow and it does both of those things: decision support in the workflow and including financial information.

EBO: Does the tool specifically focus on drugs under the medical benefit or can this work in the pharmacy benefit setting as well?

Valley: Yes, it includes both, actually. Our financial tools within Cardinal Health Specialty have always been rather unique in that as we approached the market, we were very focused on having a more holistic view of treatment costs. That includes both infused, reimbursable drugs for the medical benefit as well as the pharmacy benefit. And so we follow the same methodology with Decision Path. You’re able to see costs of oral and injectable or infusible drugs.

EBO: Does the tool identify treatment options based on payer formulary lists or does the tool prioritize the least expensive alternative, such as a biosimilar, regardless of formulary placement?

Valley: We also are able to show the ability or the impact of swapping out biosimilars. That’s a very key component and something that is still of avid interest. Although our recent work here at Cardinal Health and looking at biosimilar adoption is showing that in oncology, it’s just not new territory anymore to be thinking about that in terms of the biosimilar. It’s probably getting a little more complex because we have the luxury now with some [reference products] with multiple biosimilars. That’s where we think that the value will be as competition in that market and prices, cost, and patient support services are evolving to help providers get a little bit of a better handle on that in an easier, more efficient way.

EBO: Which financial aspects does the technology prioritize the most: the expense to the patients, the expense to the payers, or the expense to the practice?

Valley: It prioritizes the total cost. Then, as a corollary to that, it would be the patient’s out-of-pocket that would be estimated. Our patient out-of-pocket estimates, I’d say, at launch, are a little bit more global and there we’ll be able to be more specific as we continue to develop the product. For example, we’re already making this tool very smart in that if a payer has a certain preferred pathway regimen, we’re able to surface that to the provider easily so they don’t have to say, “Oh, well, what payer does Mrs Jones have?” We’ll service that up to them based on the information that Decision Path is obtaining from the practice management system and the patient demographic information. So we’re able to prioritize that by payer as well.

EBO: How does the technology take into account rebates and reimbursements on drugs when helping providers make treatment-based decisions?

Valley: We’re able to pull that information into the net cost of drug therapies. And so that really gets more at the providers’ level costing more so than the patient’s level costing for some of those areas. But we’ve always had the ability in all of our tool sets for providers and administrative and business personnel within the practice to understand net cost of drugs with and without GPO [group purchasing organization] rebates factored in, and that’ll continue to be an element in all of our financial tools. Within Decision Path, since we’re mostly focused on total cost of therapy and patient out-of-pocket costs, those GPO rebates and discounts aren’t as much of a factor.

EBO: How would this tool take into account interchangeable products? Would biosimilars with interchangeable designations get a higher priority over others?

Valley: We haven’t really thought through that piece of it yet. I think, at this point, with interchangeability being at its current state, we don’t have as much of a need to have that automated within the tool at this point. But again, with our strength in biosimilars, it’s certainly something that our VP [vice president] of biosimilars is supporting our team regularly to think through the when and how of how we’ll be able to service those insights.

EBO: How can technology be updated to include new therapies and indications as they’re approved? Will the updates have to be entered manually or will there be regular system-wide updates?

Valley: There will be regular system-wide updates. That’s our current practice today. We don’t really wait always for the new regimens to be entered into the system until NCCN [National Comprehensive Cancer Network] has had time to update. Although I think they’re getting faster and faster at their updates. But sometimes a new therapy is approved and we want to be able to have that in there right away. And so we do have sort of a supplement, if you will, until things are reflected in the NCCN guidelines. But that’s something we do on a regular basis and those will be automatically updated within the system.

EBO: Does the tool also take into account any drugs that are often used off label?

Valley: [It does] in the same manner that NCCN would think of those. There are many drugs throughout the NCCN guidelines that aren’t necessarily officially indicated from an FDA labeling standpoint but have compendial listings and, of course, with NCCN being a compendial listing. So I think the definition for that has already been developed in our regular business and so we would continue to follow those.

EBO: Do you have any concluding thoughts?

Valley: I think it’s very interesting as we have been developing Decision Path, talking with providers, and looking at some of the wonderful work that’s been done by the National Cancer Institute and by other groups that have really done a lot to define what financial toxicity is. So we have a really good definition of the problem, but we don’t have a lot of solutions that help us navigate the issues. And it’s just such a big issue in oncology.

So I think what we’re excited about is being able to provide a solution. One of the things we commented on publicly recently was recent data showing that over 70% of oncologists and providers view it as part of their responsibility to have these economic discussions in the treatment planning process, but fewer than 25% of them do that. And the reason is that they don’t have tools like this to put the information at their fingertips for them to consider as they’re doing treatment plans to support their conversations with patients. So we’re really excited about the potential to have a really usable, practical tool in the hands of providers and start moving to having solutions to make a difference in how we navigate financial toxicity in cancer care. 

Reference
Melillo G. With no replacement for OCM on horizon, oncology practices ask: what now?. Am J Manag Care. 2021;27(9 Spec No.):SP390. doi:10.37765/ajmc.2021.88800