Reimbursement Challenges for Oncology Innovations: Who Pays?

Competition as a means of tackling the escalating issue of drug prices is not working, said Peter B. Bach, MD, MAPP, physician at Memorial Sloan Kettering Cancer Center, in a panel discussion at The American Journal of Managed Care’s 4th Annual Patient-Centered Oncology Care Meeting. He explained that implementing a system in which the attributes of the drug determine its price is a more reasonable, value-based approach.

He was joined by John Fox, MD, MHA, senior medical director and vice president of medical affairs for Priority Health; Daniel J. Klein, MHS, president and chief executive officer at the Patient Access Network Foundation; and Yousuf Zafar, MD, MHS, associate professor of medicine and public policy at the Duke Cancer Institute. The discussion was moderated by Bruce A. Feinberg, DO, vice president and chief medical officer of Cardinal Health Specialty Solutions.

Fox added that paying for outcomes may also be a legitimate way to better price the medications cancer patients need.

“We pay a lot of dollars in the healthcare system for drugs that aren’t appropriate for our patient or don’t work as they’re predicted in the clinical trials, and I think in the future we’re interested in long-term relationships with manufacturers that are focused on paying for outcomes rather than paying whatever price they demand,” he explained.

When trying to tackle the greater issue of climbing drug costs, Klein explained that part of the problem is trying to make sure patients have access to a medication that is one-of-a-kind and, in the end, improves their health outcomes. He said that substitutes for medications and the role of the patient in their own care are 2 important talking points when looking at cancer care costs.

“If you put some kind of price in front of the consumer to help make them think about the cost of what they’re using, will they make a rational decision?” Klein asked. “And, in many cases in oncology or in hepatitis care, there really aren’t substitutes of that kind available, so it’s not a fair question to ask. So our focus is basically on making sure that people don’t have a barrier that’s going to prevent them from using a treatment that is the recommended treatment.”

Zafar explained that understanding what’s happening in the healthcare system in a broad big-picture sort of way is very different that actually putting those methods into action to achieve more cost-effective, value-based care. While physicians haven’t always been trained to think of value with the patient in mind, he is still able to do so when considering what is ultimately best for the patient, he added.