Lessons from UnitedHealthcare's stalled plan to get oncologists to prescribe generics

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A new study dives into a pilot payment program from UnitedHealthcare that aimed to boost generic anticancer prescriptions. (Getty/Wavebreakmedia)

UnitedHealthcare piloted a program aimed at getting oncologists to prescribe more generics, but the plan didn't exactly work out. 

In fact, researchers saw almost no impact for their efforts.

However, the likely design mistakes in that program offer lessons to payers looking to undertake a similar endeavor, officials said.

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Under the program, UHC offered oncologists a voluntary fee schedule that significantly boosted payments—and thus margins—for generic anticancer drugs. Researchers from the University of Pennsylvania analyzed the progress of the program from 2007 and 2016 and found that it did not have any notable impacts on prescribing rates or spending.

Atul Gupta, Ph.D., an assistant professor of healthcare management at Penn’s Wharton School and one of the study’s authors, told FierceHealthcare that UHC’s new payments did boost payouts but weren’t a “game changer” for participants. 

“It did increase margins,” Gupta said, “but it was never more than the margin of brand-name drugs.” 

RELATED: UnitedHealthcare launches bundled payments for maternity care 

The findings, the researchers said, offer a “cautionary tale” for insurers looking to design voluntary models like this.  

With voluntary models, it’s crucial to clearly establish which subset of providers to target and tailor incentives directly to them, Gupta said. The study found that many of the oncologists who joined the program already had high rates of prescribing generics, indicating selection bias. 

In addition, Gupta said, overall generic prescription rates were high before the pilot, which suggests the program could have been designed to more effectively target outlier physicians. 

That means first having data on provider mix to identify which to target, Gupta said, instead of designing a one-size-fits-all financial model. 

“It makes it a little bit interesting for them to actually enter the program,” he said. 

Another element to consider is the environment physicians practice in, which is multipayer. As they all accept Medicare, the federal government has more leverage to institute a payment change. 

RELATED: UnitedHealthcare to expand bundled payments in Medicare Advantage plans 

One from a commercial insurer, however, could get lost in the shuffle among the others they accept, the researchers said. 

“A unilateral intervention by a single commercial payer to alter anticancer drug prescribing patterns may have been overwhelmed by the multi-payer environment in which most physicians practice medicine,” they wrote. 

Gupta said commercial payers aren’t into a position to mandate a program like this one, either, which is why it comes back to ensuring the model is designed to effectively attract the target providers. 

“The reality is that commercial payers can’t really impose mandatory programs,” he said. 

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