Management of high and rising costs in oncology requires a multifaceted approach using both innovative strat­egies and pragmatic tools. Increased spend is often attributed by plan spon­sors to factors including the growing number of novel oncology therapies and expanded indications for previ­ously approved therapies. In this ar­ticle, we discuss these and several ad­ditional factors also influencing costs of oncology care, including improved patient survival, regulatory changes, increasing drug utilization, off-label drug use, and provider consolidation.

Current management methods in oncology include prior authorization, pharmacy and medical claims editing, restructured plan designs, and phar­macist- and nurse-led care manage­ment. The use of alternate sites of care for select therapies and the increased availability of genomic and other ad­vanced molecular diagnostic testing are newer additions to the portfolio of management tools.

Value-based cancer care models are emerging and represent a significant evolution of the oncology payment model. In these new models, provid­ers are rewarded for providing cost-ef­fective and higher quality patient care. With respect to management in these new models, the focus shifts away from individual point-of-care activities and instead recalibrates on a holistic view defined by episodes of care. Sev­eral prominent organizations in oncol­ogy, including the Centers for Medicare and Medicare Services (CMS), the Na­tional Comprehensive Cancer Network (NCCN), Memorial Sloan-Kettering Can­cer Center (MSKCC), and the American Society of Clinical Oncologists (ASCO) have created and launched new tools and initiatives intended to help facili­tate the adoption of value-based cancer care models.

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