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Payers Use Variety of Evidence Types to Develop Oncology Clinical Pathways

April 21, 2021

By Edan Stanley

Annie YanAnnie Yan, PharmD, manager of value & access strategy at Xcenda, a part of AmerisourceBergen, offers insight from study that evaluated payer-initiated oncology pathways (OCPs), in which trends in utilization, development, and barriers to implementation were measured.

For this study Dr Yan and her coinvestigator explained they have a strong interest in the oncology space from a market access perspective, especially given the number of high-cost medications that are entering the market in this therapeutic area and the need for manufacturers of these products to demonstrate and communicate their value.

What existing data led you and your co-investigators to conduct this research?

Clinical pathways have been around for over a decade and are used by providers and payers to promote high-value care and reduce variations in treatment approaches. There are multiple studies that demonstrate how the use of clinical pathways lead to reductions in health care resource utilization and treatment costs without compromising clinical outcomes. However, as my co-investigator and I reviewed the current body of evidence on OCP use, we noticed a paucity of data on payer utilization of OCPs within the past 5 years. Because payer coverage and reimbursement greatly impact patients’ access to treatments and market uptake of biopharmaceutical products, we felt it was important to understand whether OCPs are still widely used by payers as a utilization management strategy, and also the process behind designing payer-initiated OCPs.

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

We fielded an electronic survey in November 2020 to Xcenda’s Managed Care Network (MCN), which is a proprietary research panel that includes over 160 health care executives, medical and pharmacy directors, and other experienced individuals in managed care. Our survey specifically targeted payer advisors who have an understanding of OCPs and are involved in managing medical policies for oncology products within their respective organizations.

We had a total of 43 advisors complete the survey, 18 of whom represent payer organizations that currently use OCPs, and 16 of whom represent payer organizations that are considering implementing OCPs in the future. The remaining advisors represent organizations that do not use OCPs and have either used or considered using OCPs in the past. These results suggest that despite the information gap in the literature, OCPs continue to be a method that most payers utilize or are interested in adopting.

One interesting finding was the variety of evidence that payers consider when designing OCPs. Clinical guidelines and peer-reviewed literature were (unsurprisingly) very influential for OCP development; however, payers also use resources such as value assessment frameworks, expert recommendations, real-world evidence, drug compendia, and economic analyses to inform OCPs. This really illustrates how payers are taking a holistic view when assessing the value of health interventions.

What are the possible real-world applications of these findings in clinical practice?

Because payers are using a variety of evidence types to develop OCPs, it’s important for oncology biopharmaceutical manufacturers to generate high-quality evidence and engage in information exchange with payers. As the entities with the most information on their assets, manufacturers have the opportunity to disseminate the meaningful data they generate through various avenues such as scientific publications and participation in value framework assessments, to name a few.

Manufacturers can also use online platforms, like Xcenda’s FormularyDecisions, to engage payers and share clinical evidence and health economic information early in the FDA’s review process. FormularyDecisions is a secure online platform that facilitates information exchange between pharmaceutical manufacturers and more than 2500 health care decision makers. Through the platform, manufacturers can share credible value information at the pre-, peri- and post-approval stages and gain real-time access to payer insights about their products.  

Do you and your co-investigators intend to expand upon this research?

Our research indicates that the landscape of payer-initiated OCPs is still evolving: a large proportion of payer organizations are considering implementing OCPs in the future, while some payers stopped using OCPs. It would be interesting to monitor the state of OCPs through periodic market research and map the shifts in OCP utilization over time. It may also be meaningful for manufacturers to conduct market research regarding OCP use in order to have a more comprehensive understanding of the forces that impact market uptake of their products.

About Annie Yan, PharmD
Dr Yan is currently the manager of value & access strategy at Xcenda, a part of AmerisourceBergen. Her past research experience focused largely on health policy and its influence on health outcomes and resource utilization.

Yan A, Cook S. Evaluation of payer-initiated oncology clinical pathways: Utilization trends, development, and barriers to implementation. Poster presented at: AMCP 2021, April 12-16, 2021; Virtual.

View the full poster:

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