2019年美国癌症健康计划关注

R. Brook, M. Sax, J. A. Carlisle, J. Smeeding
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引用次数: 1

摘要

摘要背景:癌症治疗正在从化疗转向更有效的靶向免疫治疗。新疗法、一些适应症扩大的现有疗法(包括维持疗法)和许多价格上涨的疗法需要重新评估。许多代理商都是通过专业药店(SP)处理的。目的:新型肿瘤学疗法的冲击增加了人们对经济的担忧。共同保险和福利限制可能会让患者“经济上有毒”,但产生的结果证明了保险的合理性。利用免疫肿瘤学(嵌合抗原受体[CAR]-T治疗和肿瘤不可知治疗)针对分子特征的努力正在彻底改变化疗。有≥165种CAR-T疗法在试验中,三种已上市的肿瘤不可知药物与其他肿瘤药物联合使用。目的是确定管理护理计划最关心的肿瘤学领域。方法:向美国健康计划和PBM的官员发出在线调查邀请,内容包括:官员和计划信息、癌症排名(最低 = 1至13 = 最高)、自付垫底费、福利设计、癌症管理,以及今天和未来5年的关注点 从预算和医疗角度来看(POV)。结果与之前的调查结果进行了比较。结果:85名受访者完成了调查。受访者在涵盖多个成员类型(包括商业FFS)的计划中的各种委员会中任职 = 41%,医疗补助 = 70%,IDN = 57%,HMO/PPO = 22%,雇主自筹资金 = 22%。肿瘤学是排名第三的SP——疾病占85.3%↑3.5%和51.2%的受访者表示他们参加了肿瘤责任制护理/疾病管理组织;88.5%涉及肿瘤学基因组测试;13.8%的患者使用基于价值的肿瘤学合同。最令人担忧的癌症是:肺癌 = 11.1,乳房 = 10.8,结肠和直肠 = 9.7,前列腺 = 8、黑色素瘤 = 7.6,白血病 = 7.4,骨髓瘤 = 7.4,非霍奇金淋巴瘤(NHL) = 7.3,胰腺 = 5.7,肾脏 = 5.1、子宫内膜 = 4.9,膀胱 = 4.7和甲状腺 = 2.9、癌症管理为:61.2%↓7.7%的人有时不理专家,始终遵循NCCN指南67.4%↑ 6%,有时遵循其他指南或途径81.3%,53.1%有时遵循内部方案。肿瘤学在财务方面超过了其他较新的昂贵疗法——联合肿瘤学疗法排名第一 = 68%,CAR-T第二,35.3%。癌症一直是医疗保健最关注的问题(如今为47.2%,五年中为50% 年)和预算(目前为50%,5年为60.9% 年)POV。结论:肿瘤学药物的改进和免疫肿瘤学的发展具有重要意义,需要计划专注于效益设计,采用新的药物并利用途径。
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United States health plan cancer concerns in 2019
Abstract Background: Cancer care is shifting from chemotherapy to more effective targeted immunotherapies. New therapies, some existing therapies with expanded indications (including maintenance) and many therapies with price increases require re-evaluation. Many agents are handled through specialty pharmacies (SPs). Aims: The onslaught of newer oncology therapies have increased economic concerns. Coinsurance and benefit limitations can leave patients “financially toxic” but produce outcomes that justify coverage. Efforts utilizing immuno-oncology (chimeric antigen receptor [CAR]-T therapy and tumor-agnostic treatments) directed at molecular signatures are revolutionizing chemotherapy. There are ≥165 CAR-T therapies in trials, three marketed tumor-agnostic drugs used in combination with other oncology agents. The objective was to determine oncology areas of most concern to managed care plans. Methods: An online survey invitation was sent to officers of US healthplans and PBMs covering: officer and plan information, cancer ranking (lowest = 1 to 13 = highest), copays, benefit design, cancer management, and concerns today and in 5 years from budgetary and medical points of view (POVs). The results were compared with prior surveys. Results: Eighty-five respondents completed the survey. Respondents served on a variety of committees from plans covering multiple member types including Commercial FFS = 41%, Medicaid = 70%, IDN = 57%, HMO/PPO = 22% and Employer self-funded = 22%. Oncology was the third highest ranked SP – condition covered 85.3%↑3.5% and 51.2% of respondents reported they participated in oncology accountable care/disease management organizations; 88.5% covered oncology genomic tests; 13.8% used value-based contracting for oncology. The cancers most concerning were: lung = 11.1, breast = 10.8, colon and rectal = 9.7, prostate = 8, melanoma = 7.6, leukemia = 7.4, myeloma = 7.4, non-Hodgkin’s lymphoma (NHL) = 7.3, pancreatic = 5.7, kidney = 5.1, endometrial = 4.9, bladder = 4.7 and thyroid = 2.9. Cancer management is: 61.2%↓7.7% sometimes leave specialists alone, always follow NCCN guidelines 67.4%↑ 6%, sometimes follow other guidelines or pathways 81.3% and 53.1% sometimes follow internal protocols. Oncology outranked other newer expensive therapies as a financial concern – combination oncology therapy was ranked first = 68%, CAR-T second 35.3%. Cancer was consistently a top concern from medical care (47.2% today, 50% in 5 years) and budgetary (50% today, 60.9% in 5 years) POVs. Conclusions: Improvements in oncology agents and the growth of immuno-oncology have implications that require plans to focus on benefit design, adopt newer agents and utilize pathways.
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Journal of Drug Assessment
Journal of Drug Assessment PHARMACOLOGY & PHARMACY-
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