With more and more oncolytics targeting specific alterations in tumors, the area of precision oncology is developing rapidly. To help bring some insight into this market, Magellan Rx Management, a division of Magellan Health, Inc., and Trapelo Health, a wholly owned subsidiary of NeoGenomics Bioinformatics, recently unveiled a collaboration aimed at helping both providers and payers navigate this complex space and ultimately improve patient outcomes.
The offering combines Magellan Rx’s comprehensive oncology management solution and Trapelo’s precision-medicine platform, which provides fast, accurate testing and treatment decision support. Trapelo links providers, laboratories and payers by providing access to molecular testing information, allowing providers to order tests from preferred labs and interpreting those results, including identifying appropriate, evidence-based treatments. It offers automated prior authorization, incorporates health plan policies and eliminates unneeded medical redocumentation. These services will support Magellan Rx’s medical pharmacy program, which addresses various aspects of cancer care such as guideline-supported prior authorization, drug waste, personalized dosing, oral oncology management, post-service claim edits and provider network management.
“Appropriate genomic testing and appropriate drug therapy selection in oncology are inextricably tied together,” says Rebecca Borgert, Pharm.D., senior director of oncology clinical strategy and innovation for Magellan Rx Management. “It is impossible to ensure appropriate genomic testing without knowledge of available drug therapies, and, likewise, it is impossible to ensure appropriate drug therapy selection without a deep understanding of molecular genomic testing. The collaboration between Trapelo and Magellan Rx Management brings together our collective expertise in both of these areas and ties the entire process together. By providing clinical decision support for genomic testing and seamlessly using that data to drive appropriate drug selection, the promise of better patient outcomes through precision oncology is realized.”
Citing the “tremendous growth” in precision oncology over the last 10 years, Borgert states that “we are now at a point where the majority of patients diagnosed with advanced cancer require some sort of genomic molecular testing in order to ensure high quality cancer care is delivered. The pace of knowledge growth makes it difficult, if not impossible, to stay abreast of the most recent science across all different types of malignancies. Additionally, this platform provides a service that will reduce administrative burden for oncology providers by bringing together genomic testing and drug utilization workflows into a single system.”
Borgert tells AIS Health, a division of MMIT, that “the system is designed to offer clinical decision support that will lead to the most appropriate selection of both genomic testing options, as well as drug therapy. Often, there are multiple options that would be considered appropriate, and if the provider selects any of the appropriate options, the prior-authorization process will be streamlined. If the provider wishes to select another testing option or another drug therapy option, the system will default to the standard review for these items, which will be based upon the individual health plan’s utilization management protocols and will often lead to a peer-to-peer review to discuss the individual patient’s case.”
Turnaround Time Can Be Challenge
“One of the current challenges with oncology precision medicine is turnaround time,” explains Borgert. “The testing process often takes more than a week from when the order is placed until results are returned. This is an anxious time for patients and their families who are waiting on these test results. Anything that can be done to speed up the authorization process for testing will allow the lab to begin work immediately upon receipt of the order, and this will translate into a direct benefit for patients. Likewise, once the test results have been returned and a treatment plan identified, a quicker authorization process will lead directly to patients being started on personalized therapies as quickly as possible.”
Trapelo also is helping speed up the process by suggesting appropriate therapies based on a molecular test’s result. “Trapelo’s actionable results viewer presents therapies ranked by level of evidence and payer preferences with participating health plans,” says Clynt Taylor, president of Trapelo Health. “Effectively, Trapelo aims to provide every cancer patient the best chance at the best outcome by improving the speed and accuracy with which patients are matched to the optimal therapy.”
Another challenge with molecular tests is that sometimes test results may be misinterpreted.
Janine Morales, Ph.D., chief scientific officer at Trapelo Health, says the biggest issues with this are the following:
- “Therapy alignments with test results can vary widely between laboratories.
- “Therapy alignments can be based on widely different amounts of evidence, from preclinical data all the way to randomized controlled studies. In other words, some of the alignments are based on limited clinical evidence.
- “Lab reports, for the most part, do not offer clinicians a framework for deciding which, if any, of the therapies on the report are appropriate for the patient in front of them. So the risk is in the potential for confusion that leads to both overutilization and underutilization of molecular information to inform a therapy decision.”
“These problems are sometimes addressed through the use of molecular tumor boards, experts who help translate the results into a treatment plan,” Morales tells AIS. “These can be effective, but this human-intensive approach has scalability challenges.”
However, she maintains that “improved information technology can help. Highly detailed reports in which individual therapy recommendations are presented in the context of a clinically evidence-based framework that takes patient clinical details into consideration, such as stage of disease, previous treatments, overall performance status, their interest in a clinical trial, their personal care goals and their tolerance for risk.”
It’s up to each health plan to decide how it would like to use the services within its oncology provider network, says Borgert. “Since the Trapelo business model also involves working directly with provider groups, we feel confident that oncology providers will recognize the value in this offering with regard to its ability to reduce administrative overhead for their practices.”
According to Taylor, “the cost of this program is usually covered by the payer; however, Trapelo also offers the ability for oncology practices to adopt Trapelo clinical decision support capability more broadly and integrate it directly into the practice workflow through the EMR. In this configuration, there may be a cost for the practice as well.”
Asked if pharmaceutical companies have a role to play in the program’s success or ease of use, Taylor responds that while they do not have a direct role to play, drugmakers “do derive a significant indirect benefit through the success of the program. As the program is adopted by providers, it drives the appropriate testing of biomarkers for patients who need testing. This, in turn, gives more patients the opportunity to gain access to the most advanced and efficacious treatment therapies and clinical trials. This benefit has drawn the attention of pharma companies and opened dialogue with many of them regarding ways they can be supportive of the program.”
Contact Borgert via Lilly Ackley at email@example.com and Morales and Taylor via Karan Cushman at firstname.lastname@example.org.
This story was reprinted from AIS Health’s monthly publication RADAR on Specialty Pharmacy.