Impact of Specialty Pharmacy, Site of Care, and Practice Ownership on Physician Behavior

Chemotherapy dominates treatment of both ovarian cancer and endometrial cancer, although Avastin, a targeted monoclonal antibody, and Lynparza, a new oral monotherapy, offer new hope for patients with more-advanced stages of ovarian cancer. As novel treatments emerge in the oncology space, the nation’s healthcare payers are turning to management strategies to prioritize the most cost-effective therapies. Given the ever-increasing consolidation among oncology practices, hospital ownership is becoming a key factor in the delivery of cancer care. In this report, we examine the impact of several managed-care strategies on reimbursement and prescribing of ovarian and endometrial cancer drugs, including provider practice ownership models (e.g., physician-based versus hospital-based), utilization management strategies, site-of-care restrictions, narrow provider networks, and use of specialty pharmacies for oncology drug distribution.

Questions Answered in This Report:

  • Hospitals are increasingly purchasing or building up their own oncology practices, leading to increased infusions of chemotherapy at hospitals and hospital-owned clinics. How does physician alignment with independent versus hospital-based practices affect their prescribing? In what setting do oncologists’ patients receive their infused treatments? Are MCOs taking steps to restrict infusions to preferred sites of care to avoid having to reimburse administration of therapies at more-expensive hospital settings? Are MCOs mandating the use of specialty pharmacies in the treatment of ovarian and endometrial cancers, and what has been the impact on oncologist prescribing?

  • MCOs have been establishing narrow networks of low-cost providers to reduce the cost of medical and pharmacy care. How widespread is the use of narrow networks by MCOs for oncology practices? What metrics must oncologists meet to be involved in and remain in narrow networks? What is the impact of narrow networks on oncologist prescribing of cancer drugs?

  • The approval of AstraZeneca’s Lynparza (olaparib) as a monotherapy for advanced ovarian cancer in patients with the germline BRCA mutation introduced the first-in-class oral therapy for ovarian cancer. What is the status of Lynparza on MCO formularies? What has been Lynparza’s uptake? Have oncologists adhered to the narrow indications on its label? What cost controls are MCOs using on this drug now and in 12 months? Are physicians encountering difficulties being reimbursed for using the BRCA genetic test?

Scope:

The U.S. Physician & Payer Forum report entitled Managed Care Insights in Ovarian and Endometrial Cancers: Impact of Specialty Pharmacy, Site of Care, and Practice Ownership On Physician Behavior, highlights the results of primary research and adds expert managed-care analysis to probe the impact of key managed-care trends affecting oncology drugs and how they affect the prescribing of generic as well as branded cancer drugs, including Lynparza, Genentech/Roche’s Avastin (bevacizumab), and Janssen Biotech’s Doxil (pegylated liposomal doxorubicin).

Markets covered: United States.

Primary research: Online survey of 98 medical oncologists who treat patients with ovarian and endometrial cancers and 24 pharmacy directors and 16 medical directors from 40 managed care organizations.

Author(s): Paula Wade