1. Butcher, Lola

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Traditional pharmacy costs are staying steady or even dropping, but costs for cancer drugs are continuing to spiral upward. That means insurers and the employers who pay for insurance continue to look for ways to control spending for cancer care.


The new edition of Medical Pharmacy Trend Report, published by Magellan Rx Management, offers some clues into what oncologists can expect to see going forward. The report reflects survey responses in 2013 from 48 health plans responsible for more than 166 million lives.


Formularies that discourage the use of certain drugs in favor of others are increasingly important to cancer care. While non-small-cell lung cancer treatments have been under formulary management for years, those for other cancer types-metastatic breast cancer, prostate cancer, non-Hodgkin lymphoma, multiple myeloma, renal cell carcinoma, and leukemia-are now commonly under formulary management.


Other results:


* Payers who represent 46 percent of covered lives-that translates into more than 80 million people-have initiated pilot programs using bundled payments for services with large oncology groups.


* Payers intend to increase the percentage of members who have coinsurance responsibility. Coinsurance percentages range from a low of 10 percent of the cost to a high of 50 percent. Among payers anticipating copays in 2014, the average amounts ranged from $5 to $250. (Those figures are projected for 2014; survey responses were made in 2013.)


* A full 98 percent of individuals covered by the 48 health plans were eligible for palliative care as part of their general medical benefit in 2013-This is a big increase from 2012, when just 43 percent had palliation covered.


* Payers are big believers in cancer care pathways: 89 percent said oncology pathways improved costs more in 2013 than three years earlier, and 95 percent said pathways improve quality more than they did three yeas previous.


* Large employers are asking payers to provide cost-control initiatives, such as prior authorization and clinical pathways, to ensure appropriate use of oncology drugs as well as better access and high-quality care. Several payers said employers want to limit coverage of third- and fourth-line therapies of unproven value.