McKesson InterQual 2015 Adds Guidance for New Oral HCV Drugs
Spending on specialty pharmaceuticals is expected to hit 50% of drug costs for commercially insured lives by 2018, up from just 20% in 20091. Within four years, industry estimates suggest that seven out of 10 of the top-selling drugs in the United States will be specialty drugs2. Over half of the specialty drugs in the pipeline are high-cost oral medications, which are increasingly developed as substitutes for other treatments, such as injectable drugs used in physician offices, outpatient settings, or infusion centers3.
Amid this rapid industry growth, InterQual Specialty Rx Criteria play a critical role in providing payers and providers a fast and reliable way to determine the medically appropriate use of each new specialty drug. This helps reduce waste on ineffective or unnecessary treatments, and helps improve care quality.
“The growing number and cost of specialty drugs is challenging payers and providers alike,” said Laura Coughlin, RN, BSN, MBA, vice president of clinical development at McKesson Health Solutions. “Payers need to ensure medically appropriate utilization of healthcare resources, while providers need to keep pace with the latest medical evidence on these breakthrough treatments. With this latest update, McKesson continues to invest significant resources to help healthcare organizations react quickly and appropriately to medical advancements.”
New to the criteria are Harvoni, Sovaldi, and Olysio, new oral drugs to treat Hepatitis C, a condition that attacks the liver and affects an estimated 3.2 million people in the United States. These drugs cost between \\$66,000 and \\$94,000 for a 12-week hepatitis C regimen and \\$132,000 to \\$188,000 for a 24-week treatment plan. These oral agents are an alternative to the traditional one-year regimen of drug injections, previously the only option for those with HCV, at a cost of only \\$900/week but with a 10% rate of adverse effects and a 9% rate of discontinuation4.
InterQual Specialty Rx Non-Oncology Criteria gives payers and providers an objective, evidence-based resource that helps them make medically appropriate decisions regarding specialty drug use. Specialty drugs that help treat other conditions such as Crohn’s Disease, Multiple Sclerosis, Rheumatoid Arthritis, and 21 other conditions are also covered.
Each drug added to McKesson’s InterQual Specialty Rx Oncology Criteria, including the latest additions Afatinib (Gilotrif) and Vemurafanib (Zelboraf), incorporates content from the National Comprehensive Cancer Network Drugs and Biologics Compendium® (NCCN), an authoritative reference for oncology coverage policy recognized by public and private insurers, including the Centers for Medicare and Medicaid Services (CMS). McKesson clinical experts incorporate its recommendations for the off-label indications of a particular condition depending on the treatment setting.
InterQual Specialty Rx Criteria is part of the InterQual 2015 product line, McKesson’s flagship decision support solution. InterQual criteria help payers and providers ensure appropriate care to improve quality and reduce unnecessary cost across the medical and behavioral health continuums of care. The InterQual clinical development team synthesizes the most current, best evidence into a fully referenced decision support tool that is reviewed and updated annually. InterQual’s development process, honed over nearly 40 years, is founded on rigorous review of the literature, and includes extensive peer review by practicing clinical experts across the United States.
InterQual criteria can also be made part of payer or provider workflows via CareEnhance® Review Manager Enterprise and other InterQual solutions that can help streamline medical review and enable auto-authorization. McKesson also has other tools for oncology: Value Pathways powered by NCCN™, treatment pathways based on efficacy, toxicity and cost, and Clear Value Plus?, workflow-integrated regimen support technology that highlights evidence-based options for physicians.
For more information on McKesson Health Solutions, please visit our website, hear from our experts at MHSdialogue, and follow us on Twitter at @McKesson_MHS.
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