Renal Cell Carcinoma | Access and Reimbursement | Changing face of Physician Autonomy | US | 2016

Consolidation within the oncology provider community, including hospital acquisitions of oncology practices and oncology practices joining together, is changing the dynamics in the relationship between providers, health plans, and pharmaceutical companies. The gain of size through consolidation gives practices bargaining leverage and leads to more centralized decision making on the prescribing and administration of cancer therapies. Faced with a slate of expensive oral and infused therapies, including an exciting new immune checkpoint inhibitor, managed care organizations are challenged to contain their pharmacy costs for treating members with advanced metastatic renal cell carcinoma while also preserving their members’ access to life-altering therapies. This content examines how consolidation in the oncology sector has affected the reimbursement and prescribing environment for renal cell carcinoma therapies.

Questions Answered in This Report:

· Consolidation of oncology practices through hospital acquisitions and practice mergers has implications for prescribing of renal cell carcinoma drugs. How widespread is the consolidation trend among surveyed MCOs and oncologists? Have costs to health plans risen as a result? How are MCOs responding to the trend?

· Consolidation can erode the autonomy of oncologists who become employees of health systems. What reasons do some oncologists give for the loss of prescribing autonomy in the hospital setting? How does becoming part of a hospital system affect oncologists’ prescribing of renal cell carcinoma drugs? What impact do MCO-imposed utilization management restrictions have on oncologists’ prescribing?

· Consolidation has often been linked to increased use of the 340B discount drug purchasing program and physician dispensing of oral oncolytics. Are oncologists more likely to prescribe oral renal cell carcinoma drugs when they have access to their own in-house pharmacies? Are MCOs reimbursing physicians for in-office dispensing? Are physicians more likely to prescribe premium-priced therapies if they have access to 340B pricing?

Scope:

· Markets covered: United States.

· Primary research: Surveys of 100 medical oncologists and 40 managed care company officials, including 22 pharmacy directors and 18 medical directors in August 2016.

· Indication coverage: Advanced, metastatic renal cell carcinoma.

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