OBJECTIVES : The onslaught of newer Oncology therapies increased economic concerns. Coinsurance+benefit limitations can leave patients "Financially Toxic" but these newer agents produce outcomes that justify coverage. Efforts utilizing Immuno-Oncology [ie, chimeric antigen receptor (CAR)-T (gene) therapy and tumor-agnostic treatments] directed at molecular signatures are revolutionizing chemotherapy. Currently there are 165 CAR-T therapies in trials and 3 marketed tumor agnostic drugs used in combination with other oncology agents. To determine oncology areas most concerning to managed care plans.

METHODS : An online interactive survey invitation was sent to senior officers of US health plans and PBMs covering: officer+plan information,cancer ranking(lowest=1-to-13=highest),copays,benefit design,cancer management,concerns today and in 5-years from budgetary and medical points of view (POV). Results compared with prior surveys.

RESULTS : 85 respondents working for Health Plans,IDNs,ACOs,PPOs+Specialty Pharmacies (SPs) completed the survey. Respondents served on a variety of committees from plans covering multiple member types including Commercial FFS=41%,Medicaid=70%,IDN=57%,HMO/PPO=22%, Employer self-funded=22%. Oncology was the 3rd highest ranked SP-condition covered 85.3%↑3.5% and 51.2% of respondents reported they participated in Oncology accountable care/disease management organizations. 88.5% of plans covered Oncology genomic tests and 13.8% used Value-Based Contracting for Oncology. The cancers most concerning were: Lung=11.1, Breast=10.8, Colon+Rectal=9.7, Prostate=8, Melanoma=7.6, Leukemia=7.4, Myeloma=7.4, Non-Hodgkins Lymphoma (NHL)=7.3, Pancreatic=5.7, Kidney=5.1, Endometrial=4.9, Bladder=4.7, and Thyroid=2.9. When asked about cancer management 61.2%↓7.7% sometimes leave oncology specialists alone, always follow NCCN guidelines 67.4%↑6%, sometimes follow other guidelines or pathways 81.3%,and 53.1% sometimes follow internal protocols. Oncology outranked other newer expensive therapies as a financial concern–combination oncology therapy was ranked first=68%, CAR-T second 35.3%. Cancer/oncology was consistently the top concern from medical-care (47.2% today,50% in 5 years) and budgetary (50% today,60.9% in 5 years) POVs.

CONCLUSIONS : Constant improvements in oncology agents and the movement to Immuno-Oncology has great cost implications that require plans to focus on benefit design, adopt newer agents and utilize pathways.