When I say cancer care is in crisis, I mean that we have a perfect storm brewing. First, we have the graying of America, so we are going to have an increasing incidence of cancer.

The management of complex oncology drugs in pharmacy and in medical benefits presents unique challenges for all parties who seek cost-effective, positive clinical outcomes for patients with cancer. New therapies are offering the exciting prospect of improved outcomes, prolonged life, and, in some cases, a cure for specific diseases. Targeted oncolytics and pharmacogenomics, which carry the promise of improved likelihood of successful treatment, have become welcome additions to the current standards of care.

Philadelphia, PA—Fragmentation in oncology care significantly influences physicians’, payers’, and patients’ understanding of how cancer therapies lead to improved quality of care. The main reason for fragmentation is the challenge in linking pharmacy and medical data in a way that generates usable information, according to Atheer A. Kaddis, PharmD, Vice President, Managed Markets, Diplomat Specialty Pharmacy.
Philadelphia, PA—Implementing path - ways to sustain community oncology and offering additional nursing and care management models are recent strategies being adopted by various practices and payers to reduce the medical and pharmacy costs in cancer management and improve the quality of care.
The healthcare reform legislation involves many potential issues that can affect oncology, for example, how minimum benefits are defined. First, there are required minimum benefits that all health plans and other insurers have to meet, and we have to make sure that cancer care is included.
Philadelphia, PA—An expanding role for oncology pharmacy in the optimization of cancer care is likely to emerge over the next 3 to 5 years, as payers seek better outcomes for their money.
Philadelphia, PA—Growth in Medicare Part B spending, increasing roles in specialty pharmacy, formation of accountable care organizations (ACOs), and bundling of payments for care are all anticipated trends in the Medicare and reimbursement arenas.

Philadelphia, PA—The medically under - served population needs easier access to healthcare and tools that provide a seamless transition between all phases of the treatment process, from screening through therapy and survivorship. Payers play an important role in the future of oncology and need to be in the decision-making network.

Patient assistance and patient navigation programs aim to provide patients with reliable education to inform their decision-making, but these programs are sometimes referred to as “add-ons,” and they cost money.

Philadelphia, PA—The estimated cost for physician practices to interact with health insurance plans is $23 billion to $31 billion annually, according to a 2009 national survey conducted by Casalino and colleagues (Health Aff. 2009;28:w533-w543).
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