Dr Lee Newcomer on Policy Decisions as New Immunotherapy Agents Are Developed

Lee N. Newcomer, MD, MHA, senior vice president of oncology and genetics at UnitedHealthcare, discusses off-label communications and how coverage determinations are changing along with the production of new immunotherapy agents.

Transcript (slightly modified)

How are coverage determinations being made for newer immunotherapy agents? Are policies being developed for CAR-T treatments?

Our policy about making decisions on new technology has never changed. In cancer, we rely on the National Comprehensive Cancer Network (NCCN) guidelines, and so that decision is made actually external to UnitedHealthcare by about 25 of the world’s leading cancer centers. If they tell us there’s enough evidence to approve it, we approve it. CAR-T won’t be any different, nor will the new immunotherapies.

You need to develop evidence, the professionals need to recommend them based on that evidence—and that’s how we decide. The one thing about CAR-T is that it’s going to be very expensive. Those therapies will cost anywhere from half a million to $2 million per treatment, and so we are organizing both to provide the financing for that and to make sure that the right centers provide that care.

What kind of off-label information would prove useful for payers? What do you think is the impact of off-label communications?

Well again, we rely on the NCCN, so there’s plenty of evidence sometimes for off-label indications. In fact, most of the indications for cancer are off-label, but we’re looking to the NCCN to weigh the evidence to support it. So, it’s their call but the more studies you do and the stronger the studies are, the more likely you are to get a recommendation from the NCCN.