Value-Based Cancer Care Issues

July 2011, Vol 2, No 4

Value-Based Insurance Design in Oncology

Wayne Kuznar

Value in Oncology

Philadelphia, PA—The “one-size-fitsall” approach to current benefit designs does not recognize that health services have different levels of value; such an approach, therefore, lacks incentives for patients to adhere to diagnostic tests and treatments with proven effectiveness that may help to contain costs to various healthcare stakeholders. [ Read More ]

The Role of Molecular Diagnostics in Cancer Treatment

Wayne Kuznar

Cancer Care

Philadelphia, PA—The field of oncology stands to benefit greatly from molecular diagnostic trends, according to Jane F. Barlow, MD, MPH, MBA, Vice President, Clinical Innovation, Medco Health Solutions, who offered a pharmacy benefit manager’s (PBM) perspective of the role of diagnostics, including the use of companion tests in drug development. These companion tests will represent another potential expenditure and coverage decision for PBM companies. [ Read More ]

Benefit Design Trends in Oncology Management

Wayne Kuznar

Oncology Benefit Edition

Philadelphia, PA—Third-party oncology benefits management, tiered networks, and accountable care organizations (ACOs) are some of the trends gaining traction in the health insurance industry, according to Donald Liss, MD, Senior Medical Director, Independence Blue Cross of Philadelphia, who described cancer care from a large insurer’s perspective.

[ Read More ]

The Age of Personalized Oncology Therapies

Wayne Kuznar

Personalized Medicine

Philadelphia, PA—The age of personalized cancer therapies is upon us. In oncology, personalized medicine encompasses the use of tests to determine the genes and gene interactions that can reliably predict an individual’s response to therapy or the chance of disease recurrence. The use of molecular diagnostic testing that provides the genomic profile of an individual’s tumor facilitates an understanding of some specific tumors that allows the selection of a treatment most likely to induce a response in that patient.

[ Read More ]

A New Option for Metastatic Breast Cancer

Wayne Kuznar

Breast Cancer

Philadelphia, PA—The new biologic therapy eribulin (Halaven) was recently approved by the US Food and Drug Administration for the treatment of patients with metastatic breast cancer. Stephen C. Malamud, MD, Attending Physician, Beth Israel Medical Center, New York City, discussed the benefits and risks associated with this new treatment option at a special session during the meeting.

[ Read More ]

Patient Navigation and Patient Assistance Programs in Oncology

Wayne Kuznar

Patient Navigation

Philadelphia, PA—The medically under - served population needs easier access to healthcare and tools that provide a seamless transition between all phases of the treatment process, from screening through therapy and survivorship. Payers play an important role in the future of oncology and need to be in the decision-making network.

Patient assistance and patient navigation programs aim to provide patients with reliable education to inform their decision-making, but these programs are sometimes referred to as “add-ons,” and they cost money.

[ Read More ]

The Impact of Therapy Type on Clinical Fragmentation in Oncology Care

Wayne Kuznar


Philadelphia, PA—Fragmentation in oncology care significantly influences physicians’, payers’, and patients’ understanding of how cancer therapies lead to improved quality of care. The main reason for fragmentation is the challenge in linking pharmacy and medical data in a way that generates usable information, according to Atheer A. Kaddis, PharmD, Vice President, Managed Markets, Diplomat Specialty Pharmacy. [ Read More ]

New End Points Create Novel Challenges for Health Plans in Oncology Drug Management

James T. Kenney, RPh, MBA


The management of complex oncology drugs in pharmacy and in medical benefits presents unique challenges for all parties who seek cost-effective, positive clinical outcomes for patients with cancer. New therapies are offering the exciting prospect of improved outcomes, prolonged life, and, in some cases, a cure for specific diseases. Targeted oncolytics and pharmacogenomics, which carry the promise of improved likelihood of successful treatment, have become welcome additions to the current standards of care. [ Read More ]