Research Reports | Market Assessment
August 2015

Managed Care Strategies in Breast Cancer | Physician & Payer Forum | US | 2015

U.S. Payer and Prescriber Perspectives on Clinical Pathways, Bundled Payments, and Accountable Care Organizations

As the U.S. healthcare market faces an avalanche of expensive specialty drugs in the pipeline, managed care organizations (MCOs) are increasingly evaluating reimbursement through the lens of value-based, cost-efficient care. Clinical pathways have become more prevalent in cancer treatment as stakeholders seek to standardize best care and control costs. MCOs also seek to control costs and quality through bundled payments, which pay providers a single payment for an episode of care, and accountable care organizations (ACOs), which hold providers responsible for the total cost of care of a patient population. In this U.S. Physician & Payer Forum report, we examine the impact of these payment schemes on reimbursement and prescribing of breast cancer drugs—including chemotherapy regimens, hormone treatments, and targeted therapies—for the HER2+, HR+/HER2-, and triple-negative patient populations. We also discuss clinical pathways’ and bundled payments’ current and future handling of supportive care drugs to prevent and/or treat neutropenia. Forty-one U.S. MCO directors and 102 oncologists/medical oncologists were surveyed for this report.

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