Payers' Perspectives

The 2016 American Society of Hematology (ASH) meeting provided insight into new treatment options and mechanism of action choices for hematologic cancers. Health plans need to continue to expand their knowledge and expertise in all cancer types to maintain the ability to manage and apply coverage criteria appropriately as FDA approvals continue to increase in oncology.

Many significant and interesting topics highlighted at ASCO 2016 are discussed in this publication, covering clinical, safety, and economic issues related to cancer therapies. The challenge for health plans and other insurers is to balance the need to provide reasonable and appropriate patient access to new therapies and the ability to pay for them, because many new cancer treatments are designed for orphan diseases and are launched into the market at extremely high costs.

As I have discussed in previous perspectives, the human and economic toll of opioid abuse and misuse is unacceptably high. A multifaceted approach to this serious public health problem is essential and should involve all stakeholders. One emerging area of focus for the effective management of chronic pain is the role of pharmacogenomics and genetic profiling in patient selection and prescribing.
Consistent with past meetings, the 2014 annual meeting of the American Society of Hematology (ASH) included very insightful and educational presentations on the value of pharmaceuticals, cost implications, and the importance of adherence to therapy that can help guide policy decisions for pharmacy and medical directors.
Rosacea is a chronic and progressive skin condition characterized by episodes of remission and exacerbations of its many cutaneous symptoms, including flushing, facial erythema, telangiectasia, edema, papules, pustules, ocular lesions, and rhinophyma.
As usual, ample information pertaining to payers was available at this year’s American Society of Clinical Oncology (ASCO) meeting.
Hematologic cancers continue to gain awareness for payers. This is a result of the number of novel therapies recently approved by the US Food and Drug Administration to treat cancers that have few alternatives, as well as the growing number of expanded indications and use of combination therapies.
The cost of cancer care is an issue of major importance to payers in 2013. There are more than 12.5 million people living with cancer in the United States today, and that number is rising.1 According to a recent study published in the Journal of the National Cancer Institute and supported by the National Institutes of Health, “Based on growth and aging of the U.S.

The overall incidence of hematologic cancers is lower than that of solid tumor malignancies, such as lung, breast, and colorectal cancers, for payers who are responsible for keeping track of and for managing the entire portfolio of oncology. Hematologic cancers bring unique challenges from a treatment perspective and a supportive care perspective.

Over the past year, the volume and intensity of concern about the unsustainable growth of cancer care costs have mounted steadily.
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  •  Association for Value-Based Cancer Care
  • Oncology Practice Management
  • Value-Based Cancer Care
  • Value-Based Care in Rheumatology
  • Rheumatology Practice Management
  • Urology Practice Management
  • Lynx CME