National Comprehensive Cancer Network

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NCCN Academy Explores Impact of New Health Insurance Marketplaces and Defining Quality in Oncology

Jonathan Larsen, MPP, Manager, Global Business Development

On July 10 – 11, 2013, the National Comprehensive Cancer Network® (NCCN®) hosted the NCCN Academy for Excellence & Leadership in Oncology™ School of Pharmaceutical & Biotech Business at the National Press Club in Washington, DC. The two-day event was moderated by Clifford Goodman, PhD, of the Lewin Group, and Robert W. Carlson, MD, Chief Executive Officer of NCCN. NCCN Academy provides an educational forum for pharmaceutical and biotech professionals to participate in and observe interactions with key stakeholders surrounding key business, policy, coverage, reimbursement, informational, and operational issues in oncology, while gathering valuable insights into developing effective strategies for navigating the various constituencies involved in cancer care.

The July NCCN Academy featured five modules covering a broad range of oncology topics, including, but not limited to, the anticipated impact the new health insurance marketplaces, created as a result of the Patient Protection and Affordable Care Act (ACA), will have on patients with cancer and the oncology community on the whole; issues regarding effective pricing of new oncology drugs, biologics, and devices; and how various stakeholders define quality oncology care. The two-day session also included two Meet the Experts modules, which provided expert insights into the consideration and decision-making processes that result in the recommendations of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and perspectives from regulatory and reimbursement experts on current trends and challenges in the  oncology space.

The first module, The Affordable Care Act—Communicating the New Normal to Patients: Who is Responsible?, delved into how consumers, including patients with cancer, are being informed about how to make proper choices when enrolling for health insurance through the new  marketplaces. Panelists noted that many who currently lack health insurance coverage are not aware that new options for coverage, through the ACA, now exist; specifically, the panel discussed a recent survey sponsored by Enroll America which indicated that 78 percent of uninsured Americans are unaware of the new insurance options that may be available to them through the insurance marketplaces. Clinician, patient, administrative, payer, and industry issues related to ACA implementation were also discussed. Panelists expressed a need for more information to better assist eligible consumers regarding new insurance options. Concerns were voiced about the actual health insurance and the level of benefits to be provided through the new insurance marketplaces, as well as the technical infrastructure to inform the public about the marketplaces, and how these factors will impact cancer care delivery.

During the second module, Effective Pricing in a New Era: What is the Value Equation?, panelists discussed issues surrounding the pricing of oncology drugs, biologics, and devices in a time when rapid evolution of medical technology continues and the cost of oncology care remains high. Moreover, the impact that drug costs are having on hospital formulary development was discussed. Of particular note, Leonard Saltz, MD, Chief of the Gastrointestinal Oncology Service and Head of the Colorectal Oncology Section at Memorial Sloan-Kettering Cancer Center, spoke about his experience at Memorial Sloan-Kettering Cancer Center, where a drug was kept off the hospital formulary in late 2012 due to its high price as compared to the current existing treatment options available at that time. Sylvia Bartel, RPh, MHP, Vice President of Pharmacy at the Dana-Farber Cancer Institute, noted that the same drug was added to the hospital formulary in order to ensure access the new therapy, should it be medically necessary. The panel's discussion focused on the challenges of assessing value and managing costs, especially in light of advances in molecular testing. Members of the panel touched on multiple areas including how outcomes data, cost, and patient needs factor in to determining what value is in oncology care. The panel also recognized regulatory compliance requirements as a driver of high costs, as well as the fact that many oncology drugs are not expected to go off patent until 2020-2022, when an increase in generic oncology drugs may drive costs down.

The first day was closed with the Meet the Regulatory and Reimbursement Experts module, where panelists provided expert insight on issues regarding the U.S. Food and Drug Administration (FDA) "breakthrough" designation for oncology products, evidence requirements for drug approvals, and the impact of companion diagnostics in the regulatory and reimbursement space. The panel noted the importance of collaboration between the FDA and Centers for Medicare and Medicaid Services (CMS) to establish a parallel review process in order to help increase efficiency of drug review processes. The panel also discussed the potential of improved clinical trial design to meet FDA safety and CMS coverage requirements.

Day two began with the module, Meet the Experts: NCCN Guidelines® Hot Topics, moderated by Dr. Carlson. This module included perspectives on NCCN Guidelines development from NCCN Guidelines Panel Members. Discussion focused on differing types of clinical evidence considered by NCCN Guidelines Panels based on disease type and suggestions on how clinical trial design can be enhanced, particularly as new molecular targets are identified.

The final module of NCCN Academy, Defining Quality in Oncology, addressed the challenges of defining quality oncology care, as there are multiple existing quality programs with varying elements for measurements and reporting of quality care. The challenges of collecting and measuring quality data were explored from a variety of oncology stakeholder perspectives, including industry, payer, provider, and patient advocacy. Panelists expressed the importance of developing systems that will allow for real-time quality data collection that are translatable into practice improvement.

The next NCCN Academy will be held March 12, 2014 in Hollywood, Florida, prior to the NCCN 19th Annual Conference: Advancing the Standard of Cancer Care™.  For more information about NCCN Academy for Excellence and Leadership in Oncology™ School of Pharmaceutical and Biotech Business, visit NCCN.org.