The Managed Care Oncology Index
The Changing Oncology Market
Managed care has long avoided close scrutiny of oncology. Faced with well-organized specialists and lingering fear of the bad PR associated with “denying care”, most payers have concentrated on other categories. Several concurrent trends have begun to change that:
- The Medicare Modernization Act (MMA) initiated a significant shift in the way payers manage oncology by altering the payment methodology and provider incentives.
- A number of important chemotherapies, including several cytotoxics and all of the antihormonals, will see their patents expire by the end of the decade
- Specialty pharmacy providers (SPPs) have begun to offer oncology-specific services, including oversight of distribution and tighter management of supportive care products
- Sophisticated and highly sensitive genetic diagnostics offer payers additional opportunities to manage cancer medicine
- The targeted nature of new therapies facilitates tighter access management
- Will the commercial market follow Medicare’s lead in managing oncology?
- What is the timeline for payer adoption of ASP-based payments in oncology?
- How will providers/practices react to declining reimbursement rates?
- Have changing payer coverage policies resulted in changes in off-label use?
- How will rising patient cost-sharing requirements affect utilization of targeted and biotech products?
- What impact does patient willingness-to-pay have on marketing strategy and objectives?
- Do payers’ management systems have the ability to track utilization by line of therapy?
- How do payers’ perceptions of a product’s “value” affect coverage policy and payment – particularly for biologic or targeted therapies?
Key Research Issues
The Managed Care Oncology Index is the most comprehensive and up-to-date analysis of the major trends underway in the evolving payer market for oncology. The Zitter Group works closely with clients and subscribers to frame research questions, and to ensure that each semi-annual issue provides detailed, intelligent analysis of the most important current trends.
The Managed Care Oncology Index tracks payer management of therapies for the most important solid and hematological tumor types. The study provides an accurate portrait of current coverage policies, cost-sharing burdens, and access rules, as well as their impact on utilization.
The Index also tracks management priorities, offering a portrait of the most likely oncology management strategies over the next 12-18 months, providing critical insight for product strategy. Because the study includes both payers and providers, findings from one group can be balanced against those from the other, ensuring a more accurate picture of the evolving market.
Click on the picture below to see additional highlights from the latest version of the Managed Care Oncology Index:
For a product prospectus, or if you would like more information, contact us at strategy@zitter.com.