- Programs & Services
- Cost Management
- Specialty Management
- Care Management
- Member Engagement
- Health Plan Client Engagement
Delivering value-driven care
Every cancer treatment journey is as unique as the patient. While cancer care is complex, providing members coverage for value-driven, clinically appropriate treatment in a timely manner, shouldn't be.
Radiation oncology therapy is used in nearly two-thirds of all cancer treatment regimens globally.
Radiation therapy is an important curative treatment for many types of cancers.
Prescribers today are faced with a complicated and multifaceted process that often results in delayed care. Because every patient is unique, each treatment should be too. With no one clear source of guidelines for radiation oncologists, a lack of transparency into current information with often inconsistent, unverified third-party reviews, and an inadequate appeals process, the prior authorization (PA) process for treatment can be complex and lengthy.
|97% of procedures require PA
||73% of radiation oncologists said their patients express concern over PA delays
||15% of advanced radiation modalities are overutilized
At CVS Caremark we've created a more streamlined and quality-focused PA experience for providers that helps ensure patients receive clinically appropriate radiation therapy, with minimal delay as part of their overall cancer care. This may help improve health outcomes for patients, as well as increase value for health plans. Our process features:
Quality – With well-established care pathways and a rigorous clinical review process that aligns with the latest NCCN, ASTRO and literature-based guidelines, we can help to ensure therapy is clinically appropriate.
Collaboration – Support from board-certified radiation oncologists facilitates reliable peer-to-peer reviews.
Innovation – Our advanced technology platform makes prescribing and billing easier by guiding providers to select the most appropriate therapy quicker, so patients get started on their treatment, faster.
|Radiation oncology represents 14% of overall oncology treatment costs
||Payors save 5.8% on radiation treatment
Innovation at the point of prescribing
With a broad set of integrated capabilities to help payors manage specialty spend across the pharmacy and medical benefit continuum, Novologix, our proprietary cross-benefit technology platform, enables a variety of strategies at the point of prescribing. This helps payors uncover opportunities to address gaps in specialty management while also providing the most appropriate benefit with quicker approvals.
Novologix features an integrated PA and medical claims management platform with site of care optimization and medical strategies to target high-cost therapies including radiation oncology. By incorporating the most up-to-date clinical guidelines that align with the American Society for Radiation Oncology (ASTRO), the National Comprehensive Cancer Network (NCCN), and evidence-based standards of care, our solution makes it easy for providers to select clinically appropriate therapy quicker, so patients can get started on their treatment faster, which can help improve health outcomes. And our board-certified radiation oncologists are also there to help support cases that require further review.
Speed, convenience, and reliability are important factors for busy providers. With our PA platform, providers can create a request in as little as six minutes and get a decision in as little as one minute. The system guides them toward appropriate treatment for the request and then helps to guide the process electronically. Complete regimen modality are available for comprehensive cancer care, rather than code-by-code authorizations, as is the case in other marketplace models. And all required documentation can be requested and submitted online, eliminating the need for multiple phone calls and faxes.
At CVS Health, we're continually building solutions that help improve oncology care experiences and health outcomes, while speeding the process and lowering costs.
The source for data in this document is CVS Health Enterprise Analytics, unless otherwise noted. CVS Health uses and shares data as allowed by applicable law, and by our agreements and our information firewall.
This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Health.
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