An Update on NCCN/NBGH Initiative to Develop Evidence-Based Cancer Treatment Recommendations

In January 2011, the National Comprehensive Cancer Network® (NCCN®) announced its partnership with the National Business Group on Health to develop An Employer's Guide to Cancer Treatment & Prevention. The Guide is intended to be a resource that can be readily applied to many aspects of the benefit life cycle, including benefit planning and implementation; Request for Proposal (RFP) development, review, and scoring; vendor management; plan administration and evaluation. The Guide will address issues related to cancer across the continuum of care (see figure, below), including prevention and wellness; medical, pharmacy, and behavioral health benefits; employee assistance programs (EAPs); and disability and family medical leave. Recommendations are supported by evidence and knowledge from a wide range of experts. Therefore, anyone using the Guide can be confident that their benefit dollars for cancer are invested wisely and meet the needs of employees and their dependents.

The first project deliverable, the Quick Reference Guide and Assessment Tool, was released earlier this year. The second resource, the Benefit Design and Assessment Tool, is now available on the Business Group's web site. An Executive Summary that describes the entire project can also be found there.

The Benefit Design and Assessment Tool addresses medical, pharmacy, and behavioral health benefits. It provides specific recommendations, objectives, and suggestions for coverage and employee cost-sharing as well as "administrative guidance" to put each recommendation into context. Recommendations incorporate evidence-based clinical information from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) when applicable. This tool is designed to assist employee benefit managers as they evaluate their current cancer-related benefits and consider modifications for the next benefit cycle.

This resource provides detailed coverage recommendations on a wide range of topics, including the following:

Medical plan benefits

Adequacy of the cancer provider network, both in the community, in academic centers and NCI-designated cancer centers;
Transplant and cancer "centers of excellence programs";
Coverage for second opinion services and consultation with physicians about treatment options;
Coverage of routine costs of care when beneficiaries enroll in a clinical trial;
Hospice benefits, with specific eligibility and coverage recommendations;
Dental services, including services required prior to cancer treatment and services needed to restore function following treatment;
Fertility preservation prior to treatment for individuals whose cancer treatment is likely to cause infertility;
Medical nutrition services for those whose cancer diagnosis and/or treatments affect their nutritional status;
Molecular testing, consistent with NCCN Guideline recommendations; and
Genetic testing and counseling for those at high risk for developing cancer.

Behavioral health services covered by the medical plan

Depression screening and assessment of other behavioral health issues when provided by oncologists or other network providers;
Collaborative care services; and
Access to behavioral health providers that practice in cancer centers, including children's hospitals.

Pharmacy plan benefits

Affordable copayment/coinsurance and maximum out-of-pocket costs;
Coverage for evidence-based treatment, consistent with NCCN Drugs & Biologics Compendium; and
Parity of cost-sharing for beneficiaries between pharmacy and medical benefits for chemotherapy drugs.

The next deliverable, which will be available later this year, will translate these recommendations into RFP language and provide a scoring methodology for evaluating vendor RFP responses. This is intended to simplify the process of choosing health plans and pharmacy benefit plans and ensuring that they meet the employer's requirements.

The collaboration between NCCN and the National Business Group on Health represents an opportunity to have a powerful impact. This project will raise the bar on employer-sponsored benefits, make a real difference for cancer patients and their families, and increase the value of benefit expenditures for employers.