In a bid to better mitigate the high costs of treating cancer, MolecularHealth has introduced a product to help patients and providers better navigate through the maze of payer possibilities. Known as RxAssistance, the product is integrated into MolecularHealth’s TreatmentMAP service, which recommends specific drugs and other treatment regimens as the result of molecular testing. The patient’s test results, recommendations, and insurance coverage are examined by a professional medical coder, who then makes specific suggestions about courses of care and how much they may cost the patient out of pocket. The service is currently available for all patients with commercial coverage, and MolecularHealth officials say it is in the process of doing the same for Medicare enrollees. MolecularHealth officials say the service is intended to optimize the treatment patients are receiving by helping to ensure it remains affordable. Both pharmaceutical manufacturers and hospitals have been marking up cancer drugs precipitously in recent years. For example, Carolinas HealthCare’s Levine Cancer Institute charges $4,500 for a dose of irinotecan, a colon cancer drug that typically retails for $60. Memorial Sloan-Kettering Hospital in 2012 refused to continue providing the drug Zaltrap, which costs $11,000 a month. Partly as a result of the high […]
In a bid to better mitigate the high costs of treating cancer, MolecularHealth has introduced a product to help patients and providers better navigate through the maze of payer possibilities.
Known as RxAssistance, the product is integrated into MolecularHealth’s TreatmentMAP service, which recommends specific drugs and other treatment regimens as the result of molecular testing.
The patient’s test results, recommendations, and insurance coverage are examined by a professional medical coder, who then makes specific suggestions about courses of care and how much they may cost the patient out of pocket. The service is currently available for all patients with commercial coverage, and MolecularHealth officials say it is in the process of doing the same for Medicare enrollees.
MolecularHealth officials say the service is intended to optimize the treatment patients are receiving by helping to ensure it remains affordable. Both pharmaceutical manufacturers and hospitals have been marking up cancer drugs precipitously in recent years. For example, Carolinas HealthCare’s Levine Cancer Institute charges $4,500 for a dose of irinotecan, a colon cancer drug that typically retails for $60. Memorial Sloan-Kettering Hospital in 2012 refused to continue providing the drug Zaltrap, which costs $11,000 a month.
Partly as a result of the high price of drugs, the cost of treating some cancer patients can run more than $100,000 a year in the first year of treatment, according to data from the National Cancer Institute.
“In general, oncologists are seeing more expensive and targeted treatment options than ever before. Payers and [pharmaceutical benefit managers] are wrestling with the same,” said Laura Housman, MolecularHealth’s chief commercial officer. “This leads to a heightened and more frequent level of discussion between oncologists and payers, increasing the time and effort on the part of the oncologist and [their] staff. We aim to provide some level of added support and value to ensure patients will ultimately have access to needed therapies.”
In one specific case, TreatmentMAP recommended an off-label treatment for the patient—a drug not approved by federal regulators for that specific use but permitted if the physician approves. RxAssistance was able to confirm to the patient’s oncologist that insurance would cover the treatment before it commenced.
Takeaway: MolecularHealth is attempting to add value to its TreatmentMAP service by providing patient-specific payer data to providers ordering its tests.
