Regence partners with Puget Sound Cancer Centers for groundbreaking approach to prior authorization of erythropoiesis stimulating agents
(Seattle, WA) – Regence and Puget Sound Cancer Centers (PSCC) have collaborated to develop a unique authorization process for erythropoiesis stimulating agents (ESA), which has already shown success in the first thirty days of its inception. This collaboration recognizes the excellent performance of PSCC oncologists in prescribing ESAs using science-based physician standing orders and use of electronic medical records technology to readily provide patient information to a health plan for automatic authorization of ESAs.
“PSCC is very pleased to be a leader in fostering the development of this best-practice pharmacy pathway with Regence. This was enabled by our 2-year implementation of a comprehensive, oncology electronic medical record,” said Richard McGee, MD, F.A.C.P., president and medical oncologist at Puget Sound Cancer Centers. “We see this is as a real win for our patients. With this collaboration, we can provide ESA medications to the patients who need them, when they need them, without delay.”
The best-practice model resulted from Regence and PSCC’s 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. In the planning phase, Regence and PSCC partnered to assure physician standing orders and medication coverage policy for ESAs were fully aligned.
Regence already 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 scientific literature, in-depth analyses, and technological assessments to assure medications and medical products/services that are covered provide an overall clinical value supported by reliable science. They also consider evidence-based practice guidelines and standards developed by national organizations and based on credible scientific evidence.
“We are particularly excited about working on this collaborative model with PSCC, as it represents our shared goal of providing the best possible care to our members. Our partnership with PSCC demonstrates 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. “Regence’s policy review process assures timely policy revision and development to address evolving or newly released clinical information. This assures that we are always prepared and able to respond and make coverage decisions based on the most current evidence.”
When evaluating cancer medications, or cancer-related services/products such as ESAs, Regence considers national practice guidelines in policy development along with other sources such as scientific information and national compendia. Puget Sound Cancer Centers shares the company’s philosophy of following the current science and best practices to ensure that patients receive the care that is right for them. Based on this mutual respect for patients’ best interests, Regence and PSCC established an automated process whereby the PSCC notifies Regence of patients needing authorization and Regence automatically processes the authorizations knowing that the clinic is adhering to current science-based medicine and practice guidelines. PSCC will still provide the necessary documentation, but it will be evaluated and managed after the approval is granted rather than prior to treatment.
PSCC was able to demonstrate through existing documentation that they are adhering to best practice guidelines for prescribing ESA medications. With physician standing orders that mirrored Regence medication coverage policy for ESAs, the two organizations partnered to find a different and more efficient way to address the safe use of ESAs in PSCC patients. In the first 30 days of the program, PSCC has demonstrated use of best practice guidelines in 100 percent of patients. If this model continues to show good results, both Regence and PSCC are open to continuing the process for the long term.
About Puget Sound Cancer Centers
Puget Sound Cancer Centers (PSCC), located in Edmonds and North Seattle, is the single largest medical oncology practice in the State of Washington, and as a member of the US Oncology network, PSCC participates in one of the nation's largest cancer treatment and research organizations. This affiliation enables PSCC to bring the latest advances in therapies, clinical research and technology to patients in the communities they serve. PSCC is independently owned and managed by its member oncologists. For more information, visit www.pscc.cc.
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.