Enabling Better Oncology Treatment Decisions

BRIEFING
October 24, 2018
Vice President and Chief Medical Officer, Specialty Pharmacy, CVS Health

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.https://www.ncbi.nlm.nih.gov/pubmed. New treatments are entering the market at an unprecedented pace. In 2017, the U.S. Food and Drug Administration (FDA) approved 48 manufacturer applications for cancer treatments: 16 novel drugs and biologics, 30 supplemental indications for therapies already on the market, and two biosimilars.https://blogs.fda.gov/fdavoice/index.php/tag/oncology-products-approved-in-2017/. This pace of development means that oncologists need to take in an enormous amount of information if they are to provide their patients with the best and most up-to-date treatment. The sheer volume of information, for many, is an insurmountable burden.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286181/.

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.https://www.nccn.org/.

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.https://www.nccn.org/annualreport/default.aspx. In aggregate, the Guidelines cover 97 percent of cancers affecting patients in the U.S. and enhance safety by enabling:

Checkmark Evidence-based, personalized patient care Checkmark Reduced medication errors Checkmark Anticipated and managed adverse events
Checkmark Evidence-based, personalized patient care
Checkmark Reduced medication errors
Checkmark 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.https://www.nccn.org/about/news/newsinfo.aspx?NewsID=157. Many commercial insurers also use the NCCN Compendium (derived from the Guidelines) to determine what drugs to cover in cancer treatment. These off-label uses are especially significant in oncology, a field in which the pace of clinical innovation is much quicker than the regulatory process — an estimated 30 to 50 percent of oncology drug prescriptions are for indications other than those included on the drug’s FDA-approved label.https://www.cancertodaymag.org/Pages/Summer2017/Going-Off-Label-Targeted-Therapy-Immunotherapy.aspx. A single oncology patient’s treatment can drive a great deal of spend. By improving treatment precision, we can help control costs for payors, while also ensuring that oncology patients have the opportunity to receive the current standard of care — that the right medications, based on the most up to date evidence, are used to treat each patient.

Ensure Right Oncology Drug Regimen at Lowest Net Cost

Ease of Use for Providers

Real-Time Decision Support

Optimized Therapy Selection

  • Single front-end interface facilitates a streamlined, crossbenefit PA experience
  • Approval for multi-drug regimen in a single authorization
  • Effortless navigation through the NCCN Drugs and Biologics Compendium within NovoLogix
  • Ability to review all NCCN-supported regimens prior to treatment selection
  • Cancer treatment regimens with high level of evidence and/or NCCN panel consensus
  • Peer-to-peer review by oncologist for off-guideline regimen requests
  • Regimen-level dosing limits to help drive appropriate and cost-effective therapy

Ease of Use for Providers

  • Single front-end interface facilitates a streamlined, crossbenefit PA experience
  • Approval for multi-drug regimen in a single authorization
  • Effortless navigation through the NCCN Drugs and Biologics Compendium within NovoLogix

Real-Time Decision Support

  • Ability to review all NCCN-supported regimens prior to treatment selection

Optimized Therapy Selection

  • Cancer treatment regimens with high level of evidence and/or NCCN panel consensus
  • Peer-to-peer review by oncologist for off-guideline regimen requests
  • Regimen-level dosing limits to help drive appropriate and cost-effective therapy

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:

Checkmark 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.
Checkmark 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:

1

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.

2

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.

3

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.

4

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.

1

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.

2

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.

3

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.

4

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

Herceptin used in combination with anthracyclines
(e.g., Adriamycin, Ellence)

Checkmark

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
Checkmark

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

Herceptin used in combination with anthracyclines
(e.g., Adriamycin, Ellence)
Checkmark

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
Checkmark

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.

Want to learn more about how integrating NCCN Guidelines into NovoLogix enables better oncology treatment decisions? Ask Us
BRIEFING
October 24, 2018
Vice President and Chief Medical Officer, Specialty Pharmacy, CVS Health
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