Optimizing Oncology Therapy Selection

Better Management for Complex Regimens

VIDEO (2:58)
September 17, 2019
Vice President, Specialty Strategy and Client Solutions, CVS Caremark

Oncology accounts for 37 percent of all medical pharmacy spend.CVS Caremark Analytics, 2018. As treatments for oncology expand and costs continue to rise, managing appropriate therapy selection becomes more important than ever for payors looking to control costs. One way to do this effectively is by following evidence-based guidelines for oncology regimens.

The National Comprehensive Cancer Network (NCCN), an alliance of 28 leading cancer centers, publishes clinical practice Guidelines to help inform therapy decisions. The Guidelines cover 97 percent of all cancers affecting patients in the U.S., are widely regarded as the gold standard, and are one of the official sourceshttps://www.nccn.org/about/news.aspx for determining whether the Centers for Medicare & Medicaid Services will reimburse for off-label oncology drug use.

In 2018 alone there were more than 500 updates made based on evolving treatment landscape.https://www.nccn.org/professionals/physician_gls/default.aspx#site. This means that oncologists need support to keep up with the rapid pace of change and ensure they are prescribing the most appropriate and cost-effective treatment regimens for their patients.

Beginning in 2018, we partnered with NCCN to directly integrate the Guidelines into Novologix, CVS Health’s proprietary technology platform and serve as the clinical backbone of multi-drug regimen prior authorization for physicians and patients. The integration enables streamlined, automated PA process. Review and approval of PA requests at a regimen level rather than for individual therapies helps ensure clinical efficacy, enhanced safety and better cost management.
 

The integration offers:

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A single front-end interface and effortless navigation through the NCCN compendium

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The ability to review all NCCN-supported regimens prior to treatment selection, enabling real-time decision support.

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Regimen-specific dosing authorizations that drive clinical appropriateness and claim accuracy

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Optimized therapy selection supported by peer-to-peer oncologist review and panel consensus for treatment regimens

Want to learn how you can better control oncology costs for your plan? Ask Us
VIDEO (2:58)
September 17, 2019
Vice President, Specialty Strategy and Client Solutions, CVS Caremark

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