Making Informed Treatment and Coverage Decisions in Multiple Myeloma

Steven Peskin, MD, MBA, FACP: [What is managed care’s role in referring patients into clinical trials?] We have talked with organizations about working with them, collaboratively, to advance patients appropriately into clinical trials. We’re not specifically an organization that’s focused on enrolling patients in clinical trials. Those are certainly considerations for private practice oncology groups, certainly very much in the ethos and the fabric of academic cancer centers and National Cancer Institute-designated comprehensive cancer centers. We’re looking to advance, through data analytics, information that can help our clinical partners to make better clinical decisions, but we’re not in the clinical trials world per se.

Targeted therapies in hematologic malignancies have been transformative [in the treatment landscape]. The CML example that’s used all the time, where a very targeted-specific therapy that addressed a certain defect, the Philadelphia chromosome, really fundamentally changed that disease and moved it into a chronic condition much like diabetes, or asthma, or something like that. And, there are other examples. In the realm of multiple myeloma, there have been some very important and exciting breakthroughs that are tied to specific therapies for specific single-nucleotide polymorphisms. So, that’s certainly something we’re very sanguine about, and look at from a medical policy standpoint.

[There is a] broad array of treatment options in multiple myeloma, and they certainly are increasing. One of our very important roles, as our work with our clinical partners advances and deepens in a truly collaborative way, is to provide an analytic overlay. Some of that can be complementary to what the clinical organizations are doing, and sometimes, it’s very distinct and unique to our data set. Then, we can offer (for example), information to primary care around their medical neighborhood—so, [let them know] which oncologists, cardiologists, urologists are practicing more and more value-based care. That can be a way for that primary care office or organization to determine where she or he wants to send referrals. Now, we’re talking specifically about cancer. Similarly, we’re involved in certain analytics that will help to identify and perhaps, predict—this notion of predictive analytics. Again, we’re working to harmonize our data analytic efforts with our clinical partners, and cancer care is certainly one of those areas.

In not only multiple myeloma, but also in non—small cell lung cancer, and in non-Hodgkin’s lymphoma (so, really in most areas of cancer), immunotherapy and targeted therapies will play or occupy an increasingly important and prominent role. It’s certainly part of what’s a very exciting construct of the Cancer MoonShot 2020. We’re going to be accelerating the science and the knowledge to better and more precisely target or treat particular types of multiple myeloma. Not all multiple myeloma is the same, so that’s where we see some very exciting possibilities. We certainly feel like, as a payer, that we’re at the forefront in that regard.