Today, checkpoint inhibitors — a type of immunotherapy that blocks checkpoint proteins and helps stop the spread of cancer — span 22 different oncology disease states including breast, endometrial, kidney, colon and rectal, melanoma, and the most common in the U.S. for 2021, lung cancer.
Significant advancements in clinical outcomes, such as progression-free survival, overall survival and duration of response, are seen in a myriad of cancers and can be attributed to the continued progressive growth of this category of oncology medications contributing to the $71 billion total oncology drug spend in 2020.
That’s why it’s important for health systems, hospitals and infusion clinics to have a drug use policy and strategic financial plan that ensures appropriate operational policies that benefit your health system, hospital, or infusion clinic. It’s highly anticipated that the number of drugs, indications and total drug expenses will continue to rise, so having a policy in place could help decrease revenue loss and prevent future financial challenges.
Vizient has spent years working to help members reduce their spend and improve patient care, developing several approaches to assist with oncology pharmaceutical spend. Below are four strategies to assist in the management of checkpoint inhibitors:
- Know your current checkpoint inhibitor pharmaceutical spend
- Track the current spend of each agent utilized in the inpatient and outpatient care areas to determine current usage and assist in future drug expense projections based on updated national treatment guidelines and additional indications granted by the FDA.
- Develop drug usage guidelines with your institution’s Pharmacy & Therapy committee to restrict the inpatient use of these medications.
- Leverage a physician specialty, such as breast or melanoma, within your organization to help predict utilization of a particular product for that specialty disease.
- Choose an appropriate site of administration
- Establish outpatient infusion sites for care across your health system for the best patient experience.
- Ensure payer approaches are efficient and effective
- Confirm approval or prior authorization for the use of medication with the patient’s insurance provider prior to infusion of the drug to ensure any payer prerequisites are met, such as prior authorization or site of care restrictions, among others.
- Talk with payers to negotiate acceptance or continued acceptance of administration at your institution’s outpatient infusion clinic.
- Strategize with your finance department ways to track denial claims and communicate denials with pharmacy.
- Monitor payer cost mitigation strategies, which may include specialty pharmacy distribution channels as well as white bagging, an arrangement where a patient’s medications are sent directly to the site of care.
- Consider aggregation network opportunities
- Investigate if your GPO has aggregation networks that can offer evidence-based best practices for oncology and help drive savings on medications while achieving high-quality patient outcomes.
Using these various methods to set up a drug use policy for your oncology spend will help you keep costs down while also continuing to provide excellent patient care. It’s through mitigation strategies like these that will help us dramatically decrease the total oncology spend in future years.
For questions and additional information on Vizient resources, please email firstname.lastname@example.org.
Carina Dolan is the Senior Director for Clinical Oncology and Pharmaceutical Outcomes with the Center for Pharmacy Practice Excellence at Vizient, a health care performance improvement company in Irving, Texas. Prior to joining the Vizient team, Carina is an oncology specialty trained pharmacist with Hematology/Oncology and BMT experience in the acute care hospital setting, as well as in outpatient chemotherapy infusion centers mainly at the University of Alabama at Birmingham. Throughout her career she has continued to expand her role from clinical pharmacist to clinical coordinator, manger and co-residency director of a Hematology/Oncology specialty residency. Carina holds a Pharm.D. from Roseman University, School of Pharmacy, and is a Board-Certified Oncology Pharmacist.