It should be up to doctors, not insurers, to decide what drugs will work best for cancer patients, according to new guidelines from an oncology group.
The American Society of Clinical Oncology (ASCO) is pushing back at insurers’ efforts to force patients to try less expensive drugs before using more expensive cancer-fighting medications, even against doctors’ recommendations. The ASCO released recommendations this week that it hopes insurers will follow.
The ASCO, which released a statement (PDF), said insurers should put patients first rather than pressing them to fail with the use of less expensive cancer drugs before trying more expensive alternatives.
The oncology organization said it opposes payer-imposed utilization management policies that may restrict or deny coverage for selected treatment, including access to high-quality, high-value cancer care. “In modern cancer care there is frequently a lack of interchangeable clinical options, and that optimal cancer care requires patient access to the most medically appropriate drug at the most opportune time based on the highest quality evidence,” the group said.
High-quality clinical pathways are payers' best first option to ensure appropriate use of cancer drugs, the ASCO said.
The ASCO in January joined with the American Medical Association and 16 other healthcare organizations to push insurers to reform prior authorization and utilization management processes to approve medical tests, procedures, devices and drugs for patients.