Reimbursement Intelligence survey shows tools payers beginning to use to restrict prescribing
Online PR News – 09-November-2012 – Madison, NJ – Mechanisms like cancer pathways and more sweeping initiatives that shift provider compensation away from fee-for-service to accountable models are giving payers and at-risk providers greater leverage to say “no” to products that come with high price tags but similar efficacy and safety profiles, said John Whang, MD, COO of Reimbursement Intelligence (RI).
As proof, Whang cites the November decision by Sanofi to reduce the price of their recently approved colorectal medicine Zaltrap® (ziv-aflibercept) so that its cost is in-line with competing products after physicians at Memorial Sloan-Kettering Cancer Center published a high profile op-ed in the New York Times.
“Sanofi launched the drug with a price tag that was more than double Avastin, yet influential guideline groups like the National Comprehensive Cancer Network (NCCN) rank the two products as essentially equivalent. Using information from Kantar Health, Sanofi originally pegged its price to a much higher dose of its competitor, Avastin, than is routinely used by physicians, a mistake experts in the field quickly zeroed in on,” noted Whang.
“Zaltrap’s drastic price reduction, coming just months after the drug won regulatory approval, is an early warning that in oncology, which has largely been free of reimbursement pressures, products are facing increased scrutiny because of the value they deliver for their cost,” he added.
Indeed, as part of an ongoing evaluation of changing payer tactics in oncology, RI surveyed 50 pharmacy and medical directors at regional and national payers representing more than 100 million covered lives. Among the critical insights: survey data showing, regardless of plan size or location, payers rank high-priced oncology products like Zaltrap as the most important driver contributing to unsustainable cancer care costs.
Just as importantly, payers and providers will use tools like clinical pathway programs to limit the use of oncologics they believe are over priced relative to the value they deliver. According to the RI survey, 61% of US payers indicate they are using– or plan to use –clinical pathway programs to better control the costs associated with high incidence, high cost cancers, according to data released by Reimbursement Intelligence.
These data were part of RI’s broad-ranging Reimbursement Intelligence Oncology Series (RIOS), an in-depth analysis of how leading payer organizations are approaching the management of oncology care, including their adoption of oncology clinical pathways, the formation of oncology ACOs, and changing attitudes to oral oncologics, biomarkers, and companion diagnostics.
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