Product Code: DMKC0142369
The costs of treating cancer in the US are spiraling upward, and payers have taken notice. The growing focus on value and quality has driven greater use of clinical pathways: structured, standardized, evidence-based patient management plans that typically favor the most effective, least toxic, and lowest cost treatment options. Providers implement pathways to align treatment with best practices, and payers have used pathways in several models that tie incentives to oncologists' adherence to on-pathway treatment.
Results from recent research with US payers suggest that the trend is toward a growing market for pathways, with a significant proportion of payers expecting the use of oncology pathway programs to increase. Given the potential of clinical pathways to open up markets to oncology medicines - or to erect significant barriers to their use - the pharmaceutical industry needs to carve out a more substantial role in the development or implementation of pathway-based payment programs, while bearing in mind that pathways are only one of the many tools that payers are using as they shift from paying for volume to reimbursing value.
This report addresses the following questions:
- Who is developing and using oncology clinical pathways?
- What is the role of oncology pathways in the evolving oncology cost management strategies?
- What impact have oncology pathways had on the oncology drug use so far?
- What are the drivers and resistors of wider use of oncology pathways from the perspective of different stakeholders?
- What key developments in the US reimbursement landscape are likely to influence the use of oncology pathways in the future and what will their impact will be?
- What strategies do pharmaceutical companies need to implement to mitigate the potential negative impact of oncology pathways on their oncology products or maximize opportunities?
TABLE OF CONTENTS
- 1. The growing need for better management of oncology costs
- 2. Overview of oncology clinical pathway programs
- 3. The impact of pathways on oncology
- 4. Oncology pathways and pharma
- 5. Future of oncology pathways
MANAGEMENT OF ONCOLOGY COSTS
- 6. As oncology spending grows, so does payers' use of utilization controls
- 7. Clinical pathways - what, who, and where?
- 8. Bibliography
ONCOLOGY CLINICAL PATHWAY PROGRAMS AND DEVELOPERS
- 9. Oncology pathway developers
- 10. Design and structure of pathways
- 11. Bibliography
THE IMPACT OF PATHWAYS ON ONCOLOGY
- 12. A minority of US payers have implemented oncology pathways, but many expect use to
- 13. Research and company-reported data suggest that pathways help standardize treatment and
- save money in oncology
- 14. Drivers and resistors to the use of oncology pathways from different stakeholder perspectives
- 15. The place of pathways in the changing oncology payment landscape
- 16. Bibliography
ONCOLOGY PATHWAYS AND PHARMA
- 17. Remember that the pathway's first step is in the clinical development program
- 18. Oncology pathway inclusion will increasingly hinge on available biomarkers
- 19. Open the transparency dialog with third-party pathway vendors
- 20. Off-pathway and "ahead-of-pathway" messaging can drive success at the margins
- 21. Recognize that oncology pathways could be protective for novel, high-priced therapies
- 22. Bibliography
FUTURE OF ONCOLOGY PATHWAYS
- 23. Fragmentation or consolidation: the jury is still out
- 24. The limited role of patients could be expanding
- 25. Oncology medical societies will help drive pathways to progress in the private and potentially
- the public sector
- 26. Pathways will enter public sector payment models as components of larger APMs
- 27. "Big data" in medicine: help or harm for pathways?
- 28. Bibliography