Managed Care and Oncology Pharmacy Management: Focus on Multiple Myeloma

Tuesday morning at the Academy of Managed Care Pharmacy (AMCP) 24th Annual Meeting in San Francisco featured a satellite symposium that focused on the evolving role of managed care and oncology pharmacy management. The presentations by distinguished faculty reviewed current evidence-based data to enable decision making based on indicators of treatment outcomes for multiple myeloma; demonstrated the use of comparative effectiveness research (CER) as a decision support tool; and evaluated innovative pharmacy benefit models and specialty management services.

Here are some of the highlights from the session’s presenters:

Carol Ann Huff, MD, Associate Professor of Oncology and Medicine, Johns Hopkins School of Medicine, started things off with her presentation “Response Rates: Progression-Free Survival, Quality of Life: Defining Managed Care Outcomes for Multiple Myeloma Treatments.”

Huff showed data that clearly shows the improvement of overall survival rates for multiple myeloma patients over the past decade. However, when it comes to predicting outcomes, there still seems to be conflicting data. For instance, it’s unclear whether response to treatments can predict survival. According to Huff, this is because benchmarks differ (minimal response, very good partial response, complete response, etc), the definition of “response” differs, and, until recently, remission was very rare outside of transplantation. Huff then presented data showing that time to progression, but not response, predict survival. In addition, depth of response may be a surrogate marker for survival in high-risk patients.

C. Daniel Mullins, PhD, Professor, Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy presented on “Applying Formulary and Benefit Design Innovations.” One of Mullins’ primary objectives was to discuss the use of CER as a decision support tool to appropriately invest resources and reduce treatment variability with multiple myeloma therapies.

Mullins called attention to several oncology evidence gaps. According to the National Cancer Care Network, 50% to 75% of all cancer drugs are being used off-label. Additionally, a survey of oncologists found that at least 87 distinct oral anticancer therapies are used outside of labeled indications. These evidence gaps, according to Mullin, can be bridged with the use of Oncology CER as a decision support tool. The reason is CER evidence requirements are based on outcomes, not surrogates, making them more clinically meaningful. With more focus on patient-centered outcomes, oncology CER can reduce variability in outcomes and costs.

Kelly Bugos, MS, NP, and Jack Aiello, multiple myeloma survivor and patient advocate, spoke about "Supportive Care Requirements and Coordination of Patient-Centered Care." The pair of presenters recommended methods to improve patient outcomes by way of supportive care within a health plan setting. Using himself as a case study, Aiello called to attention the numerous struggles that go along with fighting multiple myeloma. For instance, among some of the recommendations with respect to treatments with bisphosphonates were the following:

• All patients receiving primary myeloma therapy should be given bisphosphonates
• Zoledronic acid = pamidronate (reducing skeletal events in randomized trials)
• Zolendronic acid > clodronic acid (reduced skeletal effects; reduced mortality by 16%; extended median overall survival by 5.5 months)

Bugos and Aiello went on to discuss treatments for various other ailments that impact patients with multiple myeloma, such as bone health and disease, renal dysfuncation, several types of pain, peripheral neuropathy, infection, anemia, and thrombosis. They ended by stressting the importance of a coordinated team approach, saying that communication between the cancer care team, primary care provider, and specilaty pharmacy were crucial to improving patient outcomes.

For more infomation regarding the AMCP 24th Annual Meeting, please visit www.amcp.org.