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Considerations Related to the Coverage of Immuno-Oncology Therapies
During this one-on-one interview, a part of the Oncology Stakeholders Summit, Spring 2015 series, Michael Kolodziej, MD, discusses payer considerations regarding coverage for new cancer treatments such as immuno-oncology therapies.
Dr Kolodziej, national medical director of oncology strategy for Aetna, remarks that the PD-1 agents, including the FDA-approved checkpoint inhibitors pembrolizumab and nivolumab, have generated a great deal of excitement in the oncology community. These drugs are related in terms of their mechanisms of action, and Dr Kolodziej describes the potential opportunity for oral oncolytics to be managed by class effect. Rather than payers deciding whether or not certain drugs will be treated as a class, it is likely that companies or physician groups that develop treatment pathways will recommend a limited number of agents, taking into account safety and efficacy data and drug cost.
Payers’ coverage decisions are currently reflective of FDA approvals and recommendations from the National Comprehensive Cancer Network (NCCN), notes Dr Kolodziej. “Payers tend to respect, at least initially, the FDA label and subsequently expert opinion like that offered by the NCCN. I would say that if a payer made a decision that was in conflict with NCCN, they’d be in a very difficult place to defend that decision.”
Higher Life’s Essential 8 Scores Associated With Reduced COPD Risk
November 21st 2024Higher Life’s Essential 8 (LE8) scores, especially those reflecting lower nicotine exposure and better sleep health, are inversely associated with chronic obstructive pulmonary disease (COPD) risk, emphasizing the importance of cardiovascular health (CVH) in disease prevention.
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Exploring Racial, Ethnic Disparities in Cancer Care Prior Authorization Decisions
October 24th 2024On this episode of Managed Care Cast, we're talking with the author of a study published in the October 2024 issue of The American Journal of Managed Care® that explored prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.
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Study Highlights Key RA-ILD Risk Factors, Urges Early Screening
November 20th 2024This recent study highlights key risk factors for rheumatoid arthritis–associated interstitial lung disease (RA-ILD), emphasizing the importance of early screening to improve diagnosis and patient outcomes.
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New Study Finds Risk Groups, Outpatient Care Barriers in Chronic Liver Disease
November 20th 2024Patients with chronic liver disease who were unable to establish care were 85% more likely to require recurrent hospitalizations. This group included a disproportionate number of women and individuals with physical limitations affecting their health.
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