Plans Will Begin to Monitor Practices to Identify Unnecessary Drug Treatments, According to the Recent West Health Plan Analysis
NASHVILLE, Tenn.--(BUSINESS WIRE)-- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that the rising costs of oncology drugs are forcing self-insured employers in Arizona, Colorado and Nevada to re-evaluate treatment coverage as a medical benefit. According to the recent West Health Plan Analysis, health insurers in the West have typically kept oncology treatment as a medical benefit, rather than a pharmacy benefit, because the lower costs have ensured that patients complete their course of treatment.
However, the report finds that this could change if treatment costs continue to rise. While treatments such as Celgene’s Abraxane, Pfizer’s Epirubicin and tamoxifen citrate are evaluated for overall survival, remission and toxicity, most oral oncology drugs are covered as a medical benefit by plans in the west regardless. As a way to monitor and lower costs, insurers will begin to aggressively monitor treatment practices to identify unnecessary drug treatments that do not improve member health, although they will not determine the best treatment practices.
“The challenge for health insurers and pharmacy benefit managers is keeping prices low enough that members complete their treatment,” said Bill Melville, market analyst with HealthLeaders-InterStudy. “Carriers have already begun to move to greater oncology management. As oncology drugs prove themselves to be more effective than other treatments, there will be a greater shift for preferred oncology treatments, such as intravenous and injectable breast cancer drugs.”
Other topics highlighted in the recent West Health Plan Analysis, which covers Arizona, Colorado and Nevada, include:
- Strategies health plans are using to ensure diabetic members stick with treatment plans
- The effect MLR standards have had on the individual and small-group markets
- Strategies Medicare Advantage and Part D carriers are implementing to improve their star rating scores
Why Pharmaceutical Company Managed Markets Teams Need Health Plan Analysis
Health Plan Analysis identifies key health plan trends, allowing pharmaceutical companies to create comprehensive strategic plans and sales strategies at state and local levels. Updated quarterly, Health Plan Analysis provides a detailed look at plan design and financials, as well as information about mergers, legislation and other influencers driving healthcare in a particular region.
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