NASHVILLE, TN-The rising costs of oncology drugs are leading self-insured employers in Arizona, Colorado, and Nevada to re-evaluate treatment coverage as a medical benefit. A recent West Health Plan Analysis indicates that plans will begin monitoring practices to identify unnecessary drug treatments.
The West Health Plan Analysis points out that health insurers in the west typically report oncology treatment coverage as a medical benefit rather than a pharmacy benefit. This is because lower costs ensure that patients can complete their treatment courses.
However, a report by HealthLeaders-InterStudy indicates that oncology treatment costs will continue to rise. In response, insurers will start to more aggressively monitor treatment practices to identify unnecessary drug treatments that aren’t directly linked to member health improvement – though the insurers won’t 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 in a press release detailing the study.
“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.”
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