Clinicians Should Be Able to Rely on Coverage for Category 2B Treatments: Eric Lander, MD

Eric Lander, MD, site research leader at Minnesota Oncology, spoke with The American Journal of Managed Care® after participating in the Institute for Value-Based Medicine® meeting held in Minneapolis on June 17. The panel Lander participated on focused on several topics revolving around National Comprehensive Cancer Network (NCCN) guidelines and how their recommendations are practiced in real-world settings.

In this video, Lander discussed the difficulties that clinicians and pharmacists face when trying to obtain treatments for their patients that are included in the NCCN guidelines under category 2B. Insurance companies, he said, should trust the panel of experts who have determined that these treatments are safe for use in patients with cancer.

Transcript

Are clinicians experiencing challenges with coverage for NCCN category 2B recommendations?

Last night, there was an important question that was brought up about category 2B recommendations in the NCCN guidelines, and if providers are experiencing difficulties getting coverage for category 2B treatments in the NCCN. The answer is, we polled the audience, and basically every provider in the room and many pharmacists in the room raised their hands saying that they, on a weekly basis, run into struggles getting treatments covered if they are category 2B treatments in the NCCN guidelines. I can provide a number of personal examples of patient stories where this has been a big struggle, where I've had cases where there is limited data due to the rarity of the disease, yet we could extrapolate data from other diseases and likely demonstrate benefit.

If you look at how category 2B is defined, it means that 50% or greater of panelists felt that, in their expert opinion, these are academic expert opinions who are experts within their field at academic centers, stating that they feel that this should be a viable treatment option for patients. Even though we don't always have perfect, large, prospective, randomized trials or even large phase 2, single-arm, prospective studies to support a category 1 recommendation, in many cases, we still have to be able to fall back on the category 2B recommendations to provide the best care for our patients. We should be trusting the academics who are making these decisions to include them in the NCCN guidelines. These are people who work hard day-in [and] day-out to advance our field. They are, generally speaking, very trustworthy people, and are focused on patient care and patient outcomes. This is something that, even if there is not perfect evidence, we should trust their expert opinion in that they have treated thousands of patients with these malignancies. We need to use that to guide our decision-making when data otherwise doesn't exist.