
Few fields in medicine move as quickly as oncology. The volume of published research is enormous: A search for “human cancer” in the PubMed database maintained by the National Institutes of Health returns almost 94,000 articles for 2017 alone.
Starting this fall, we are partnering with the leading oncology not-for-profit National Comprehensive Cancer Network (NCCN) to provide physicians with a tool to access the latest evidence-supported information and help payors better manage this therapeutic category. Treatment Guidelines from the NCCN will be directly integrated into Novologix, CVS Health’s proprietary technology platform, and will serve as the clinical backbone of multidrug regimen prior authorization (PA) for physicians and patients.
NCCN is an alliance of 27 leading cancer centers whose clinical practice Guidelines cover all aspects of oncology, and are widely regarded as the gold standard. The organization has more than one million registered users, with more than eight million Guideline downloads last year.
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Evidence-based, personalized patient care | ![]() |
Reduced medication errors | ![]() |
Anticipated and managed adverse events |
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Evidence-based, personalized patient care |
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Reduced medication errors |
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Anticipated and managed adverse events |
So important are the Guidelines in shaping clinical practice that the Centers for Medicare & Medicaid Services has chosen them as one of its official sources in determining whether off-label uses of drugs will be reimbursed under Medicare and Medicaid.
Ensure Right Oncology Drug Regimen at Lowest Net Cost
Ease of Use for Providers |
Real-Time Decision Support |
Optimized Therapy Selection |
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Ease of Use for Providers |
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Real-Time Decision Support |
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Optimized Therapy Selection |
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Novologix delivers precise cost management strategies that help ensure optimal regimen selection, regardless of benefit, while also helping reducing waste. With the NCCN Guidelines incorporated into the cross-benefit PA and electronic PA (ePA) processes enabled by the Novologix platform, we are transforming what is too often a pain point and an administrative burden into a decision support tool for physicians, while also dramatically enhancing the efficiency of the PA process.


The integration will begin with NCCN Guidelines for the treatment of breast, colorectal, and non-small cell lung cancer (NSCLC). When the physician logs into the online tool and enters a specific cancer diagnosis, the system will present a list of treatment options comprised of the most appropriate and evidence-based drug regimens based upon the current standards of care for that cancer type and curated by NCCN. If the physician selects one of the recommended options, the entire regimen will be automatically approved.
Novologix offers payors a flexible cost-control strategy through:
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Full guideline alignment: The ability to adopt the entire library of NCCN Guidelines for a comprehensive range of treatment options that offer greater provider treatment selection flexibility. |
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Guideline customization: Customized strategies to support your unique plan’s oncology goals and management philosophy. Our flexible oncology program can increase management intensity and help drive cost-effective regimen selection by allowing you to determine treatment coverage to meet your plan needs. |
The system offers several benefits for physicians:
It provides the most up-to-date information. NCCN Guidelines are constantly being updated. In 2017 alone, for example, NCCN issued 127 “Flash Updates,” each containing dozens of additions, deletions, and adjustments to best practices. Because Novologix links directly to the Guideline database, it automatically presents the most recent Guidelines as soon as they become available through NCCN.
It offers regimen-level PA across benefits. Many cancer treatments consist of multiple drugs. In a conventional PA system, the clinician would have to submit the three drugs separately for approval. In the Novologix system, they are submitted together — even regimens that mix drugs covered under the medical benefit with drugs covered under the pharmacy benefit. This not only saves physicians time and helps reduce the possibility for error, but it also provides vital feedback about drugs that should or should not be used together.
The system offers physicians easy access to the data that underlies the NCCN recommendations, allowing them to learn more about new treatment options (as well as existing options) at the moment when they most need it and are most likely to engage with the information.
While the system offers quicker, easier approval for NCCN regimens designated as having Categories 1 and 2 Level of Evidence and Consensus, it does not prevent physicians from pursuing other treatment choices — though those would have to go through a peer-to-peer review for potential approval.
It provides the most up-to-date information. NCCN Guidelines are constantly being updated. In 2017 alone, for example, NCCN issued 127 “Flash Updates,” each containing dozens of additions, deletions, and adjustments to best practices. Because Novologix links directly to the Guideline database, it automatically presents the most recent Guidelines as soon as they become available through NCCN.
It offers regimen-level PA across benefits. Many cancer treatments consist of multiple drugs. In a conventional PA system, the clinician would have to submit the three drugs separately for approval. In the Novologix system, they are submitted together — even regimens that mix drugs covered under the medical benefit with drugs covered under the pharmacy benefit. This not only saves physicians time and helps reduce the possibility for error, but it also provides vital feedback about drugs that should or should not be used together.
The system offers physicians easy access to the data that underlies the NCCN recommendations, allowing them to learn more about new treatment options (as well as existing options) at the moment when they most need it and are most likely to engage with the information.
While the system offers quicker, easier approval for NCCN regimens designated as having Categories 1 and 2 Level of Evidence and Consensus, it does not prevent physicians from pursuing other treatment choices — though those would have to go through a peer-to-peer review for potential approval.
Breast Cancer Regimen Selection, Traditional PA vs. Novologix with NCCN Example
Traditional Single Drug PA Process |
Novologix Integration With NCCN |
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Herceptin used in combination with anthracyclines |
![]() May inadvertently allow inappropriate regimen to be approved and utilized |
![]() Would not approve potentially harmful combination Per NCCN Breast Cancer Guidelines, combination should be avoided due to significant cardiac toxicity |
Perjeta not used in combination with Herceptin Treatment without Herceptin significantly diminishes clinical efficacy and value of chemotherapy regimen |
![]() Does not enforce co-administration with Herceptin |
![]() Would approve Perjeta in combination with Herceptin to help ensure efficacious therapy Per NCCN Breast Cancer Guidelines and Perjeta FDA label, Perjeta should always be given in combination with Herceptin |
Traditional Single Drug PA Process |
Novologix Integration With NCCN |
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Herceptin used in combination with anthracyclines (e.g., Adriamycin, Ellence) |
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![]() May inadvertently allow inappropriate regimen to be approved and utilized |
![]() Would not approve potentially harmful combination Per NCCN Breast Cancer Guidelines, combination should be avoided due to significant cardiac toxicity |
Perjeta not used in combination with Herceptin Treatment without Herceptin significantly diminishes clinical efficacy and value of chemotherapy regimen |
|
![]() Does not enforce co-administration with Herceptin |
![]() Would approve Perjeta in combination with Herceptin to help ensure efficacious therapy Per NCCN Breast Cancer Guidelines and Perjeta FDA label, Perjeta should always be given in combination with Herceptin |
Convenient, current, and focused on ensuring the use of the most evidence-based and up-to-date therapy for each patient, the Novologix & NCCN collaboration will turn the PA process into a vital part of physician practice, enabling them to spend more time with their patients. It also offers payors tighter control of their oncology spend and lays the foundation for a transition to value-based reimbursement in oncology. Ultimately, we believe this leads to the realization of a goal that all stakeholders in oncology share: better, more informed decisions in support of patients who are undergoing complicated treatment regimens and, often, battling for their lives.
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By 2020, nearly half of all specialty medication spending will be under the medical benefit, making it critical to have a comprehensive cost management strategy in place across benefits.
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