2008 oncology trends: Views from payors, specialty pharmacy, and oncology providers

Abstract

e20750 Background: Kikaku International Research was engaged by Genentech USA to conduct survey research among four key stakeholder groups involved in the financing, management and delivery of cancer care and drugs. Methods: Surveys were distributed and collected from January to June 2008. Survey questions addressed issues on volume of services, utilization of specialty pharmacy, management methodologies and degrees of involvement, volume and staffing levels in oncology practice, oncology physician staffing and retirement, payor evaluations, cost and impact of public and private payor reimbursement policies, Average Selling Price (ASP) and Medicare Modernization Act (MMA) issues and use of guidelines/pathways. Results: Managed Care Organizations: Ninety (90) managed care professionals responded. Key findings addressed: anticipated shifts in cancer spending from the medical benefit to the pharmaceutical benefit, adoption of ASP-based reimbursement and revaluation of professional fees. Specialty Pharmacy Providers: Forty-two (42) specialty pharmacy professionals responded. Key findings: total revenues and volume from cancer drugs and supportive care, distribution of drugs to patients and physician offices, Injectable drugs and oral drugs precription volume, patient education and disease management. Oncologists - Surveys were returned by 139 oncologists. Key findings: workloads and patient loads, income declines, drug margins declines, buy and bill volume. Oncology Practice Managers: Sixty (60) oncology practice managers responded to surveys about practice management, billing and reimbursement. Key findings: payer coverage and reimbursement policies, ASP rates, health plan contracts, negotiation of fee schedules. Conclusions: The conclusions of each section of the survey, when combined in aggregate, paint a picture of a very complex topic with wide variation in both approach and recommendations for how each segment addresses the specialty. Disconnects, challenges and opportunities observed in evaluating the responses include perspectives on ASP, Medical vs pharmaceutical benefit, contract negotiations, disease management, pharmaceutical management. [Table: see text]