ASCO: Clinical Pathways the Most Appropriate Utilization Management Strategy for Cancer Drugs
In a new policy statement, the American Society of Clinical Oncology (ASCO) states that well-designed clinical pathways should be the first choice of payers, while cautioning that other health utilization strategies for cancer drugs may limit patient access.
Health insurers often use different models – such as prior authorization, step-therapy protocols, restrictive formularies, and specialty tiers – to optimize resource utilization management, especially in regards to high-cost prescription drugs. However, such strategies may pose barriers for patients with cancer to receive high-quality prescription drugs. Furthermore, ensuring adherence with different health plan policies is a major concern for health clinics.
ASCO, along with the American Medical Association, have raised concerns about these models reducing patient access to quality care and subsequently developed resource utilization principles to bring about reform. Their new policy statement, published on ASCO’s website (April 18, 2017), provides these recommendations:
- Prior authorization policies must be streamlined to avoid unnecessary barriers, delays in care, and other administrative burdens.
- Utilization management policies must protect patient access to medically appropriate care.
- High-quality clinical pathways provide an appropriate utilization management strategy for cancer drug treatments when adequate patient safeguards exist.
ASCO believes that appropriately-designed, quality clinical pathways should be the first choice of payers to ensure optimal utilization of cancer drugs and the delivery of high-value care. The recent proliferation of clinical pathways in oncology have raised concerns about their development and implementation and have created an administrative burden for oncology care providers. Nonetheless, ASCO recommends that clinical pathways be the first-choice health model for payers.
The new policy reminds payers and providers to adhere to ASCO’s Criteria for High-Quality Clinical Pathways in Oncology (November 2016) when developing and promoting clinical pathways to alleviate these concerns.
ASCO asserts that, “We understand and share concerns about cost and have engaged in a wide range of efforts to ensure appropriate use of cancer therapies. Any strategies to address cost, however, must first protect patient access to the most appropriate therapy for treatment of their cancer.” – Zachary Bessette