Regence expands program for prior authorization of erythropoiesis stimulating agents
Following successful pilot, company extends process to additional US Oncology-affiliated practices
(PORTLAND, Ore.)—A successful pilot program with Puget Sound Cancer Centers has spurred Regence to expand a unique authorization process for erythropoiesis stimulating agents (ESA) to two additional practices in Oregon affiliated with US Oncology. Willamette Valley Cancer Institute in Eugene and Northwest Cancer Specialists in Meridian Park now prescribe ESAs using evidence-based physician standing orders that mirror Regence’s medication policy for ESAs.
“Willamette Valley Cancer Institute is pleased to provide our patients pharmacy treatment guidelines as part of our collaboration with Regence,” said David Fryefield, M.D., medical director and radiation oncologist at Willamette Valley Cancer Institute. “The collaboration helps ensure our patients have timely access to ESA medications through an efficient, evidence-based process.”
This model resulted from Regence and the practices’ mutual recognition of safety concerns about ESAs and following current science and best practices to ensure that patients receive the care that is right for them. After achieving high adherence in prescribing ESAs at Puget Sound Cancer Centers, US Oncology approached Regence about establishing a similar program at Willamette Valley Cancer Institute (WVCI) and Northwest Cancer Specialists (NWCS).
“The program implemented in Puget Sound resulted from considerable discussion and collaboration between the physician leaders of the three practices and leaders at US Oncology,” said Kevin Olson, M.D., medical oncologist and practice president with Northwest Cancer Specialists-Meridian Park.
“We were pleased to see the pilot success in Seattle and wanted to offer the same quality ESA prescribing service to our patients who need relief from chemotherapy-induced anemia.”
Regence has a well-established and nationally recognized evidence-based medicine review process for the evaluation of new medications, biologics and medical technologies. The company’s medication policy team performs systematic reviews of the most up-to-date scientific literature and in-depth analyses to assure that medications provide overall clinical value. They also consider evidence-based practice guidelines and standards developed by national organizations and based on credible scientific evidence.
“The success of our pilot program with Puget Sound Cancer Centers is an example of how health insurers and providers can work together to find solutions that transform the health care system,” said Lynn Nishida, director of Pharmacy Services for Regence. “We look forward to the continued success of this collaborative model with US Oncology, as it demonstrates our shared respect for members’ best interests and the importance of using current science-based medicine and practice guidelines to guide decision-making.”
Working in concert with Regence’s review process is US Oncology’s Level I Pathways. Developed by physicians affiliated with the US Oncology network, Level I Pathways are evidenced-based treatment guidelines that reduce treatment variability and resulting costs while providing a platform for standardization, outcomes measurement and ongoing peer review. Pathways are used in conjunction with iKnowMed, an oncology-specific electronic medical record that allows around-the-clock physician access to patient records, as well as practice and national trend analysis. Level I Pathways are in use in the US Oncology network of practices for breast, colon, prostate, pancreatic, ovarian and lung cancers as well as hematologic diseases such as myeloma, lymphoma and chronic lymphocytic leukemia. Pathways for radiation oncology services are also in use; survivorship and palliative care pathways have been developed.
Both Regence and US Oncology share similar philosophies of following current science and best practices to ensure that patients receive the care that is right for them. WVCI and NWCS have established a process whereby the clinics notify Regence of patients needing authorization. Regence automatically authorizes the order, knowing that the clinics are adhering to current science-based medicine and practice guidelines. The practices provide Regence with the necessary documentation via electronic medical records, but the evaluation is performed after the authorization has been granted.
About US Oncology
US Oncology, headquartered in Houston, works closely with physicians, manufacturers and payers to identify and deliver innovative services that enhance patient access to advanced cancer care.
US Oncology supports one of the nation’s foremost cancer treatment and research networks, accelerating the availability and use of evidence-based medicine and shared best practices.
US Oncology’s expertise in supporting every aspect of the cancer care delivery system—from drug development to treatment and outcomes measurement—enables the company to help increase the efficiency and safety of cancer care. According to the company’s last quarterly earnings report, US Oncology is affiliated with 1,227 physicians operating in 485 locations, including 92 radiation oncology facilities in 39 states. For more information, visit the company’s Web site, www.usoncology.com.
Regence is the largest health insurer in the Northwest/Intermountain Region, offering health, life and dental insurance. Regence serves three million members as Regence BlueShield (in Washington), Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah and Regence BlueShield of Idaho. Each health plan is a not-for-profit independent licensee of the Blue Cross and Blue Shield Association. Regence is committed to improving the health of our members and our communities, and to transforming our health care system. For more information, please visit www.regence.com.
Special note to reporters: A further description of Regence's medical/medication policy development and the sources used in the consideration of policy development is found in greater detail at www.regence.com/policy.