The NCCN Evidence Blocks

Ted Okon, MBA: We’re talking about Abacus, ICER (Institute for Clinical and Economic Review), NCCN (National Comprehensive Cancer Network), and ASCO (American Society of Clinical Oncology). What is that? Drug, drug, drug, and drug. I know it’s really popular in the press to slam the [drug] companies and to focus on the drug price. The drug price is an issue. Of all the components of care, it is the most rapidly growing.

But, it’s so refreshing to hear from someone who’s getting the calls every day about what’s happening and stating that it’s a larger picture than just the drug. If you look at it at the end of the day, it’s not just about an Abacus tool, or an ASCO tool, or an NCCN or ICER tool. It’s about what’s really important to patients—yes, the drug is important, but it’s these other costs, as well.

James Gilroy: I fully agree with that. What I’ll say about the Evidence Blocks is that NCCN, as an organization, has really built an amazing brand on evidence. That’s what that organization has done over time.

The domains around the Evidence Blocks—the efficacy, the safety, the quality of evidence, the consistency of evidence—a lot of that they’ve done already, and they’ve been able to sort of provide guidance to the practicing community around what guidelines should look like relative to those things. I think the Evidence Blocks is the addition of that fifth component, which is affordability.

This is really done with a very myopic focus on drug cost. I think that while I stated the brand’s been built around evidence, I think the evidence and the methodology behind how you get to affordability in these Evidence Blocks is still relatively misunderstood—at least to me and a number of my colleagues—as to what they say and then, ultimately, the process for getting there and how many boxes ultimately wind up getting shaded in.

For the most part, if you compare that to [the] acquisition cost of the drug relative across the blocks that they’ve released, I think you see relative consistency—but there are outliers. And, again, I think it’s somewhat a narrow way to try and prescribe that fifth block and say, “This is what it represents affordability-wise to any one specific patient.”

What I really like is the intent for that discussion. It is not a calculator that ultimately spits out one number and says, “You should look at this particular patient” or “You’re not going to be able to afford this product.” There's a number of things that that conversation ultimately can drive to. If there’s a low ranking on affordability, meaning that the product is particularly expensive, let’s talk about co-pay assistance. Let’s talk about patient assistance programs and the generous programs that a number of companies provide. Let’s enhance that conversation, making sure that it’s happening. Not all the way to Dr. Kolodziej’s point around calculation of net health benefit, but a step in that direction.