Amy Valley, vice president of clinical strategy and technology solutions at Cardinal Health, details the company’s Decision Pathway, a health information technology (IT) tool that can assist practices with prescribing patients the lowest-cost product, including biosimilars.
Can you describe Cardinal Health’s Decision Path and explain how the technology works?
Valley: Yes, so Decision Path is the latest addition to our Navista TS platform, which is really designed to help oncology practices be successful at value-based care. I think everybody’s acutely aware that the oncology care model is ending, which has been the CMS’ demonstration model over the past 6 years. We don’t know exactly what’s coming next but we’re certain that there will be successor programs.
In the meantime, many of our practices have gone on to develop their own types of value-based agreements and incentive programs with the commercial payers in their region. So, even those practices who are waiting for what’s coming next in CMS, they’re going forward and continuing to enhance their care coordination programs and all of the other investments they’ve made in care transformation so that they can be successful as this journey from fee-for-service to value-based reimbursement continues.
Does the tool specifically focus on drugs under the medical benefit, or can this work in the pharmacy benefit setting as well?
Valley: Yes, it includes both, actually. Our financial tools within Cardinal Health’s specialty have always been rather unique in that as we approached the market, we were very focused on having a more holistic view of treatment costs. That includes both infused, reimbursable drugs for the medical benefit as well as the pharmacy benefit. And so, we follow the same methodology with Decision Path. So, you’re able to see costs of oral and injectable or infusible drugs.
Does the tool identify treatment options based on payer formulary lists or does the tool prioritize the least expensive alternative, such as a biosimilar, automatically, regardless of formulary placement?
Valley: We also are able to show the ability or the impact of swapping out biosimilars. That’s a very key component and something that is still of avid interest. Although, our recent work here at Cardinal Health and looking at biosimilar adoption is showing that in oncology, it’s just not new territory anymore to be thinking about that in terms of the biosimilar. It’s probably getting a little more complex because we have the luxury now with some [reference products] with multiple biosimilars. That’s where we think that the value will be as competition in that market and prices, cost, and patient support services are evolving to help providers get a little bit of a better handle on that in an easier, more efficient way.How does the technology take into account rebates and reimbursements on drugs when helping providers make treatment-based decisions?
Valley: So, we’re able to pull that information into the net cost of drug therapies. And so, that really gets more at the providers’ level costing more so than the patient’s level costing for some of those areas. But we’ve always had the ability in all of our tool sets for providers and administrative and business personnel within the practice to understand net cost of drugs with and without GPO [group purchasing organization] rebates factored in, and that’ll continue to be an element in all of our financial tools. Within Decision Path, since we’re mostly focused on total cost of therapy and patient out-of-pocket costs, those GPO rebates and discounts aren’t as much of a factor.
How would this tool take into account interchangeable products? Would biosimilars with interchangeable designations get a higher priority over others?
Valley: We haven’t really thought through that piece of it yet. I think, at this point, with interchangeability being at its current state, we don’t have as much of a need to have that automated within the tool at this point. But again, with our strength in biosimilars, it’s certainly something that our VP [vice president] of biosimilars is supporting our team regularly to think through the when and how of how we’ll be able to service those insights.
How can technology be updated to include new therapies and indications as they’re approved? Will the updates have to be entered manually or will there be regular system-wide updates?
Valley: There will be regular system wide updates. That’s our current practice today. We don’t really wait always for the new regimens to be entered into the system until NCCA has had time to update. Although, I think they’re getting faster and faster at their updates. But sometimes a new therapy is approved and we want to be able to have that in there right away. And so, we do have sort of a supplement, if you will, until things are reflected in the NCCN guidelines. But that’s something that we do on a regular basis and those will be automatically updated within the system.
Does the tool also take into account any drugs that are often used off-label?
Valley: [It does] in the same manner that NCCN would think of those. There are many drugs throughout the NCCN guidelines that aren’t necessarily officially indicated from an FDA labeling standpoint but have compendial listings and, of course, with NCCN being a compendial listing. So, I think the definitions for that has already been developed in our regular business and so we would continue to follow those.