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
- Given the maturation of the ASP reimbursement market, how will the payer-practice financial relationship develop? How might this relationship impact patient cost and patient access?
- Payers maintain excessive end of life treatment and inappropriate utilization are the primary drivers of excess cost in oncology care. Would encouraging earlier palliative care and use of less expensive therapies really worsen outcomes, as oncologists contend?
- What are the long-term implications of patients self-rationing treatment for chronic conditions when faced with increasing out-of-pocket costs for oncology care?
- How do state treatment mandates alter payers’ management of the oncology category?
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 Managed Care Oncology 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 image below to see highlights from the latest edition of the Managed Care Oncology Index:
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