Cancer is a devastating disease that, with early diagnosis and treatment, can be overcome. According to the Business Group’s 2020 Large Employers’ Health Care Strategy and Plan Design Survey, 74% of employers cited cancer as one of the three top conditions impacting their health care costs in 2019. Employers can play a valuable role in an employee’s cancer journey through providing access to evidence-based, equitable care, while mitigating costs and unnecessary waste in the process. Below are eight recommendations for ensuring that your employees are receiving quality, cost-effective care:
- 1 | Strive to establish reasonable out-of-pocket thresholds so that cost is not a barrier for patients to obtain medications, including maintenance and supportive care drugs.
- 2 | Incorporate evidence-based cancer treatment (in medical plans, pharmacy benefit management programs [PBM], specialty pharmacy plans, and other relevant programs), building on guidance from the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN).
- 3 | Encourage appropriate application of personalized medicine including genomics.
- 4 | Consider steerage to specialized cancer centers for complex cases. According to the Business Group’s 2020 Large Employers’ Health Care Strategy and Plan Design Survey, 26% employers cited expanding centers of excellence to include additional conditions such as cancer as their top priority in addressing high cost claimants.
- 5 | Explore adopting oncology payment models developed by your carriers or providers that may incentive effective use of care utilization and adopt bundled payments for more routine cancer treatments.
- 6 | Encourage members to seek second opinion and use navigation services, if available.
- 7 | Promote and incentivize timely prevention screenings.
- 8 | Consider first dollar coverage for additional preventive testing, such as more frequent mammograms if recommended based on prior health history.