Addresses Multi-faceted Issues Intrinsic in Oral Oncolytic Treatment

Issues in Oral Oncolytic Treatment

23 February 2010

COA Study Addresses Multi-faceted Issues Intrinsic in Oral Oncolytic Treatment

Oral oncolytics have been around for many years, now, and many more are in drug company pipelines.  Some of them are available in both oral and IV formulations, while others are only available in the oral form.  With oral oncolytic treatment set to escalate in usage, multiple issues must be addressed.  Community Oncology Alliance (COA), with the help of Avalere Health, has released a study, providing a thorough review of the respective issues and offering various solutions.  Chief among these issues are costs that affect both patients and providers, compliance and side-effect management.

Costs come in two different forms, both of which coming down to insurance reimbursement from both Medicare and private payers.  Essentially, patients are expected to shoulder a much higher percentage of the drug costs, as oral oncolytics fit into the highest tier prices of prescription oral medication.  And, losing already significantly reduced IV infusion reimbursements, poses a significant loss in revenue to medical oncologists.  As oncology offices provide multiple services that are not reimbursable, the ability to be reimbursed for IV infusion therapy helps to compensate for costs associated with those services.  Further complicating matters is the inclusion by Congress of some oral oncolytics in Medicare Part B, while others are only covered in Medicare Part D. 

Compliance and side-effect management are the other serious concerns.  The convenience of taking an oral oncolytic is certainly superior to in-office IV therapy.  On the flip side is the appropriate worry of patient non-compliance.  One key reason for non-compliance is side-effects.  When a patient is forced to come to an office for IV chemotherapy, the oncologist knows the patient has received appropriate treatment and can address side-effects as they surface rather than have to rely on the patient or caregiver’s communication of such.  If the patient experiences significant enough side-effects, there is always concern of drug discontinuation without alerting the physician or office.

COA’s study presents concerns from all sides of these and other issues including input from oncologists, nurses, insurance companies and patient groups, to name a few.  Taking all issues into consideration, the article concludes with best practices on how to compensate and adjust to the inevitable increase in oral oncolytic usage.  You can view the executive summary here from COA’s website:  http://www.communityoncology.org/wp-content/uploads/Avalere-COA-Oral-Oncolytics-Study-Summary-Report.pdf.