Jennie Crews, MD
Concern over the cost of cancer drugs nearly doubled among oncology professionals from 2015 to 2016, jumping from 45% to 83%, according to the annual Trends in Cancer Programs survey administered by the Association of Community Cancer Centers (ACCC). The annual survey, taken by practice administrators (48%), nurses (29%), medical directors (6%), and pharmacists (17%), focuses on challenges and trends in oncology practice. Representatives of 166 cancer programs responded, or 24% of ACCC membership.
Although they have concerns about the cost of cancer care drugs, oncology professionals said other major issues include obtaining reimbursement for nonrevenue producing services that improve patient care (66%). They said they want more transparency in commercial policies so patients know exactly what plans do and do not cover (65%), and they said there is a need for physicians and midlevel providers to be able to focus more on direct patient care and less on paperwork (55%). They said they would also like to see increased funding for cancer research and clinical trials (53%).
One practice administrator quoted anonymously in the survey results said that his clinic had gone so far as to create a “cost transparency group” to help provide education and assistance to patients who have been prescribed high-cost chemotherapies or immunotherapies. Other comments attached to the survey indicated that respondents feel that payers should improve provider access to decision makers (officials who can give clearance for payment) so that drug approval red tape can be reduced.
Commenting on the rising concern about drug costs, ACCC president Jennie Crews, MD, said that several coping initiatives can be identified within the practice community. “One of the ways practices are responding is by hiring and training social workers or financial advocates to meet with patients and try to help with co-pay assistance and insurance coverage assessment. Additionally, there’s a lot of time spent, whether that’s through nurses or authorization experts, to try to make sure that the desired treatment is going to be covered for the patient.”
Crews also said that physicians are having to think more carefully about the costs of drugs they prescribe. Practices are also trying to become better educated about the cost of medication because this is not something many of the providers—physicians, in particular—have really been exposed to in the past.” When it comes to reimbursement for supportive care services, professionals would like to see more funding for patient navigation, survivorship care planning, and financial counseling. These are key to the success of patient-centered care and can significantly ease many of the difficulties of the cancer treatment process, Crews said. Without these programs, the quality of care is lower. “This is a huge challenge,” Crews said.
“While ACCC member cancer programs have made great strides in advancing patient-centered care, it’s clear that payer policies are lagging behind,” Crews said. “Reimbursement for these services is especially critical as we transition to new models of cancer care delivery, such as the Oncology Care Model (OCM) and the Merit-based Incentive Payment System.”
Whereas practices often struggle to provide funds for these services, many of the ACCC’s members have enrolled in the OCM from CMS, which includes supplementary per-patient payments that are intended to cover extras such as improved patient navigation, Crews said. “When you see an eligible patient, you have this payment to help cover coordination of care and some of these other services.”
Despite these initiatives to put the patient at the center of care, only 39% of respondents said financial advocates meet with all patients to discuss insurance options and cost of care, making this an issue that still needs to be addressed. Survey respondents said other types of financial assistance were being offered more broadly, such as access to pharmaceutical drug replacement programs (77%), social workers who render some financial assistance services (73%), and financial advocates or counselors (64%). Practices also offer assistance with transportation costs and gas cards (59%) and connect patients with philanthropic foundations that offer patient assistance (49%).