Ovarian and Endometrial Cancers (Managed Care Insights) | Physician & Payer Forum | US | 2015

Impact of Specialty Pharmacy, Site of Care, and Practice Ownership on Physician Behavior

Chemotherapy dominates treatment of both ovarian cancer and endometrial cancer, although Avastin, a targeted monoclonal antibody, and Lynparza, a new oral monotherapy, offer new hope for patients with more-advanced stages of ovarian cancer. As novel treatments emerge in the oncology space, the nation’s healthcare payers are turning to management strategies to prioritize the most cost-effective therapies. Given the ever-increasing consolidation among oncology practices, hospital ownership is becoming a key factor in the delivery of cancer care. In this report, we examine the impact of several managed-care strategies on reimbursement and prescribing of ovarian and endometrial cancer drugs, including provider practice ownership models (e.g., physician-based versus hospital-based), utilization management strategies, site-of-care restrictions, narrow provider networks, and use of specialty pharmacies for oncology drug distribution.