Panel Discussion

Dr Sonnad inquired how replacing brand drugs with generic equivalents can affect pathway adherence. She also asked panelist to discuss the differences between early-stage and late-stage disease regimens, as well as the degree of flexibility there is in regimen design.

The panelists further explore feedback and its role in pathway adherence.

In this segment, panelists discussed the various tools that are used to measure pathway adherence.

Dr Sonnad asked panelists about the participants on payer panels who determine the cost-effectiveness of pathways.

Dr Yu said that it is crucial for providers' voices to be heard in pathway development.

The panelists discussed and shared examples of how payers and providers are collaborating to develop pathway guidelines.

Seema Sonnad, PhD, associate editor for The American Journal of Managed Care, and director of Health Services Research at The Value Institute at Christiana Care Health System, led a panel discussion that focused on oncology clinical pathway adherence.

In this final segment, the panelists analyze the need for physician education. Dr Kumar says there is always a need for physician education because the field of multiple myeloma treatment is constantly evolving.

Dr Chernew asks panelists how patients might learn about clinical trials, and how trials handle treatment placebos.

Dr Chernew asks panelists about the role of insurers and Medicare for patients in the treatment of multiple myeloma. While insurers may not have necessarily been a barrier to care, costs of drugs have been.

The panelists discuss how diagnosis and treatment of multiple myeloma might vary within different patient populations. They also analyze the costs associated with care for the disease within different populations.

The panelists debate the costs of multiple myeloma treatment. There are costs for initial treatment, maintenance care, and the price that comes with taking multiple drugs.

Ms Young notes that while there is no cure, there has been tremendous progress in the development of newer drug classes.

The conversation shifts from diagnosis of multiple myeloma to the various benefits and risks associated with treatment. Dr Chernew comments that multiple myeloma treatment is an area of great innovation, where options for patients are constantly changing.

Dr Chernew leads the conversation to biomarkers in bone turnover and immunoglobulin expression.

Ms Young addresses MMRF's CoMMpass study, a longitudinal study that is following 1000 patients who have been newly diagnosed with multiple myeloma, from initial diagnosis over a period of at least 5 years.

Dr Kumar continues his analysis of the genetic and familial probability of a patient being diagnosed with multiple myeloma.

Moderator Michael Chernew, PhD, co-editor-in-chief, The American Journal of Managed Care, and professor, Leonard D. Schaeffer School of Healthcare Policy, Harvard, leads a panel discussion on multiple myeloma.

The panelists concluded the discussion by analyzing the concept of a cost-sharing option for patients with RA. Conceptually, their out-of-pocket costs for certain medications would be based on their medication history.

The panelists' discussion led to a conversation about quality and cost-effectiveness, especially as it relates to nonadherence. Dr Fendrick asked about the kinds of pressures patients face when it comes to paying for the drugs that they are prescribed.

When it comes to biologics like Rituxan and Remicade, which are intravenous infusions, decision making can be impacted by cost. Dr Fendrick asked the panelists what might hypothetically happen if cost was taken out of the equation when choosing between biologics and other RA treatments.

The panelists weighed in on the use of newer agents as well as anticoagulants in RA treatment. Dr Fendrick noted his appreciation of the panelists' recognition of the fact that when it comes to agents, newer isn't always better.

Dr Fendrick asked fellow panelists how they think alternative and non-pharmalogical therapies, including lifestyle changes, could help slow RA disease progression once it's diagnosed.

Dr Fendrick opened the conversation with the commonly prescribed DMARDs (disease-modifying antirheumatic drugs). But the group focused particularly on methotrexate, one of the most commonly prescribed.

This segment of the panel discussion focused on the role of primary care physicians (PCPs) in the early detection of RA symptoms. In particular, Dr Fendrick asked about the availability of protocolled guidelines that might help PCPs distinguish between RA and other kinds of arthritis.

The panelists expanded upon Dr O'Dell's comments and explored current RA diagnostic strategies as they have developed over the past 2 centuries.

Mark Fendrick, MD, co-editor-in-chief, The American Journal of Managed Care, professor, Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy, University of Michigan, moderated a discussion on the management and treatment of rheumatoid arthritis (RA).

In the concluding segment, Dr Fendrick asks the panel to provide closing remarks about the future of treating hepatitis C (HCV). Dr Afdal says he believes this is a moment in time where a revolution is taking place.

Dr Fendrick says that while indication and utilization of major innovations should be widespread, there are still questions of who will pay for them. As mentioned, plan sponsors (employers) are only 1 option.

Dr Fendrick urges the panel to discuss which tools involving benefit design are being put into place to make sure that only those patients who would benefit most from new drugs are receiving them.