Table of Contents
The costs of treating cancer in the US are spiraling upward, and payers have taken notice. The growing focus on value and quality has driven greater use of clinical pathways: structured, standardized, evidence-based patient management plans that typically favor the most effective, least toxic, and lowest cost treatment options. Providers implement pathways to align treatment with best practices, and payers have used pathways in several models that tie incentives to oncologists’ adherence to on-pathway treatment.
Results from recent research with US payers suggest that the trend is toward a growing market for pathways, with a significant proportion of payers expecting the use of oncology pathway programs to increase. Given the potential of clinical pathways to open up markets to oncology medicines – or to erect significant barriers to their use – the pharmaceutical industry needs to carve out a more substantial role in the development or implementation of pathway-based payment programs, while bearing in mind that pathways are only one of the many tools that payers are using as they shift from paying for volume to reimbursing value.
This report addresses the following questions:
- Who is developing and using oncology clinical pathways?
- What is the role of oncology pathways in the evolving oncology cost management strategies?
- What impact have oncology pathways had on the oncology drug use so far?
- What are the drivers and resistors of wider use of oncology pathways from the perspective of different stakeholders?
- What key developments in the US reimbursement landscape are likely to influence the use of oncology pathways in the future and what will their impact will be?
- What strategies do pharmaceutical companies need to implement to mitigate the potential negative impact of oncology pathways on their oncology products or maximize opportunities?
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