Oncology Pharmacy Management and the Evolving Role of Managed Care: Recommendations for a Changing Environment with a Focus on Multiple Myeloma Introduction

BACKGROUND: The treatment of multiple myeloma continues to evolve as innovative therapies increase survival times and patient quality of life. The increasing availability and utilization of these novel therapies challenge health plan administrators to create a pharmacy benefit structure that minimizes barriers to patient access while simultaneously managing costs. OBJECTIVES: To (a) enable decision making based on indicators of treatment outcomes for multiple myeloma (e.g., overall survival, progression-free survival, etc.) and markers of clinical efficacy (e.g., complete response, partial response, progressive disease, etc.); (b) coordinate oncology care and health plan medical and pharmacy management services to improve outcomes for patients with multiple myeloma; (c) enable the use of decision support tools to appropriately invest resources and reduce treatment variability with multiple myeloma therapies; (d) construct a benefit design model for multiple myeloma drugs; (e) recommend methods to improve patient outcomes with supportive care for multiple myeloma within a health plan setting; and (f) implement accurate and appropriate counsel, as part of the treatment team, that will improve patient adherence to treatment recommendations. SUMMARY: The first article in this supplement, "Identifying Indicators of Outcomes and Implementing Treatment Pathways," reviews outcomes measures typically used in phase 3 clinical trials investigating novel oncology therapies and how these measures influence clinical decision making in the treatment of multiple myeloma. The second article, "Applying Oncology Formulary and Benefit Design Innovations to the Management of Multiple Myeloma in the Managed Care Setting," discusses how comparative effectiveness research is used to generate data that can be utilized by policy makers, plan administrators, payers, and patients to identify therapies that provide the greatest value. The third article, "Multiple Myeloma: Supportive Care Requirements and Coordination of Patient-Centered Care," identifies the elements of supportive care for multiple myeloma and discusses techniques to keep the patient experience as the focal point of the treatment plan. CONCLUSION: Multiple myeloma is representative of a disease in which the introduction of novel therapies has increased survival and patient quality of life. Increasing use of these innovative yet expensive drugs has motivated efforts to redesign the oncology pharmacy benefit in a way that promotes both enhanced clinical outcomes and cost control. This process relies on robust economic and clinical data; however, these data are limited. To determine the best value-based strategies for the treatment of patients with multiple myeloma, managed care decision makers must continue to assess the evolving landscape of treatment options and consider both clinical outcomes and treatment costs in their analyses. J Manag Care Pharm. 2012;18(8-a):S3-S29 Copyright (C) 2012, Academy of Managed Care Pharmacy. All rights reserved.