Cost & Management of Oncology Combination Regimens

Overview

Oncology treatment increasingly involves combinations of novel oral and biologic drugs. While combo approaches aren’t new, there are significant cost implications of combining high priced innovator drugs (versus older, generic chemotherapies).

Payers are in a difficult spot regarding the cost and management of these regimens. Traditional utilization management tools are still difficult to apply in oncology, given no payer wants to be on the front page of a major newspaper for denying treatment. Pathways have not held up to their promise for containing cost.

Personalized medicine approaches such as biomarkers serve an important role in targeting therapy to the most appropriate patients, thereby reigning in cost. However, there are limitations in the breadth and utility of these tools. For example, PD-1/PDL-1 drugs have shown conflicting outcomes associated with receptor expression – and these drugs are the backbone for many combo regimen programs in clinical development.

Environment/perception shifts, new approaches to management, indication-based pricing or other novel pricing approaches, and innovative payment models may hold promise for controlling cost in this new era of combination therapy.

Focus

Our webinar with ZS Associates on Wednesday 30th October from 14:00-15:15 GMT / 10:00-11:15 ET included a live expert payer panel discussion on the challenges and potential solutions for managing the cost of combo oncology regimens.

Topics discussed were:

• Perspectives on oncology drug management and combination regimen pricing today
• Potential payer-driven and pharma-driven solutions to price and cost management for oncology combo regimens
• What oncology manufacturers should consider in engaging payers in the future

To view the debate on demand, please click here or on the button above or below.

Our Panel

Marcia Palmer, PharmD, MBA, Pharmacy Director

Marcia currently manages the pharmacy benefit strategy and drug formulary program for a national MCO with responsibility for Commercial, Medicare and Medicaid lives, where she coordinates and recommends as a voting member of the organization’s Pharmacy and Therapeutics Committee.

Prior to her current position, she was co-director of the Illinois Center for Pharmaceutical Care and won Health-System Pharmacist of the Year based on her extensive expertise and outstanding performance in her practice. Marcia is a licensed pharmacist in Indiana, Illinois, Arizona, and Florida. She received her Bachelor of Science in Pharmacy from Purdue University, Master of Business Administration from Loyola University, and Doctor of Pharmacy from University Illinois.

Allen W. Becker, B.S. Pharm, R. Ph., Director of Clinical Account Services, CVS Health

Mr. Becker is Director of Clinical Account Services at CVS Health, where he manages a portfolio of Clients: Large Employers, Health Plans, Government and State Medicare/Medicaid market segments, providing a full range of pharmacy benefit solutions via CVS Caremark PBM services, CVS Specialty Pharmacy, Corum Infusion Services and Silver Scripts Medicare Programs.  He also interfaces with internal partners for P&T Formulary Development, Pipeline Committee, Specialty Drug Management and DUR Development focusing on controlling trend and clinical quality for our respective clients. Prior to his over 20 years’ experience with CVS, he was the National Hospital Program Manager for G.D. Searle’s U.S. Market where he developed and implemented innovative pricing and contract strategies for the managed care market and launched Ambien CR, Calan SR and Daypro within the Group Purchasing Market business segment.

Mr. Becker received a Bachelor of Science in Pharmacy from Ferris State University in Big Rapids, Michigan, Certificate of Management Development in Health Care from the University of Southern California and attended Lake Forest School of Management.  He has also published articles in the AMCP Managed Care Pharmacy Practice on Prescription Benefit Management and did speaking engagements on Specialty Drug Management, PBM 101 and Health Care Trending for the Health Care Administrators Association (HCAA), an organization dedicated to assisting employers, administrators and healthcare professionals in managing their drug benefit.

Anthony Chiefari, BA (Bio), BSc. Pharm., Pharm.D., MS, FCCM, FLD, Senior Director for Drug Policy Development and Formulary Management

Currently, Dr. Chiefari is Senior Director for Drug Policy Development and Formulary Management, where he provides economic projections for all drugs and devices, new to market, as well as re-positioning legend drugs on the formulary as they lose exclusivity and are released from patent.

In his previous positions, Dr. Chiefari provided economic projections, reimbursement positioning, and contracting and also held the position of Advisor and Managing Director of Clinical Drug Policy and Clinical Drug Services at Universal Healthcare Services, Inc. Dr. Chiefari specializes in critical care medicine, infectious diseases, investigational drug research, cancer chemotherapy, gastro-intestinal, anesthetics, pain, respiratory/ventilation, among other areas. He is trained in Health Economics Outcomes Research, Pharmacoeconomics, and Comparative Effectiveness.

Howard Deutsch, Principal, ZS Associates

Howard is a leader in the ZS Value & Access practice and has extensive experience across a spectrum of sales and marketing issues with a focus on go-to-market strategies, in-line product growth, and market access excellence. He works with clients in the pharmaceutical and biotech industries in North America, and is a frequent author and speaker on the US healthcare landscape, and how changes in the environment are affecting manufacturers.

Howard has 15+ years of experience working with the life sciences industry, including 10+ years in US Value and Access. Howard holds an AB in Economics from Princeton University.

Nicolle Hamilton, PhD, Associate Principal, ZS Associates [co-moderator]

Nicolle is an Associate Principal in the ZS San Francisco office, and a member of the Value & Access practice. Her expertise spans across several areas including pricing, contracting, value proposition development, patient assistance and patient hub services, practice management dynamics, billing/coding, and US market access trends (e.g., innovative contracting/payment arrangements, Oncology Care Model and related payment schemes, value frameworks).

Nicolle has 10 years of experience in consulting for biopharma on pricing and market access issues. Her therapeutic area experience spans rare disease, oncology, inflammation, neurology, and others across a range of product types and settings of care.

Prior to joining ZS, Nicolle was a Director in the Pricing and Market Access Practice at inVentiv Health Consulting (formerly Campbell Alliance).

Nicolle has a PhD in immunology from the University of Washington, and a B.A. cum laude in biochemistry from Mount Holyoke College.

Dominic Tyer, Creative and Editorial Director, pharmaphorum [co-moderator]

Dominic Tyer is a trained journalist and editor with 19 years of pharmaceutical and healthcare publishing experience. He serves as a contributing editor at pharmaphorum media, which facilitates productive engagement for pharma, bringing healthcare together to drive medical innovation. He is also creative director at the company’s specialist healthcare content consultancy, pharmaphorum connect.