The Lynx Group

July 2011, Vol 2, No 4

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.
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Fragmentation in oncology care significantly influences physicians’, payers’, and patients’ understanding of how cancer therapies lead to improved quality of care.
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Implementing path - ways to sustain community oncology and offering additional nursing and care management models are recent strategies being adopted by various practices and payers to reduce the medical and pharmacy costs in cancer management and improve the quality of care.
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The healthcare reform legislation involves many potential issues that can affect oncology, for example, how minimum benefits are defined. First, there are required minimum benefits that all health plans and other insurers have to meet, and we have to make sure that cancer care is included.
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An expanding role for oncology pharmacy in the optimization of cancer care is likely to emerge over the next 3 to 5 years, as payers seek better outcomes for their money.
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Growth in Medicare Part B spending, increasing roles in specialty pharmacy, formation of accountable care organizations (ACOs), and bundling of payments for care are all anticipated trends in the Medicare and reimbursement arenas.
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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.
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The estimated cost for physician practices to interact with health insurance plans is $23 billion to $31 billion annually, according to a 2009 national survey conducted by Casalino and colleagues (Health Aff. 2009;28:w533-w543).
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