In 2022, half of our Payer survey participants said they use oncology pathways that restrict physician choice to 1-3 options with the intent to control costs and quality. Most of these Payers (67%) acknowledge that conflicts can (and do) exist between their pathways and their own coverage policies. An example of this is when a coverage policy restricts a patient from receiving a therapy that is “on pathway.”
Through numerous interviews, we’ve learned that pathway-policy “conflicts” are typically unintentional, and that Payers try to resolve them quickly.
It’s important to note, however, that our participating plans do not view pathways that simply restrict choice more than their associated drug coverage policies as conflicts:
So then, we must also ask the questions: What is Payers’ real intent and what is the utility of payer pathways? Are they more analogous to speed limit signs, speed bumps, or traffic lights? HMP Market Access Insights plans to uncover this and much more later this year in our Payer report and in greater depth in our new pathway research program.
Have some “burning bridge” access questions of your own? Let us know!
All the best . . .
—HMP Market Access Insights Team: Chris, Cindy, Lee, Nandini, and Taylor
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