COA Advocates for Biomarker Testing Access, Physician Autonomy in Cancer Care
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Nicolas Ferreyros discussed central ideas from the Community Oncology Alliance to optimize cancer care in community oncology settings.
Nicolas Ferreyros
According to the Community Oncology Alliance (COA), there is a critical need for increased and equitable access to biomarker testing to advance personalized cancer care and improve patient outcomes.1
In an interview with Targeted OncologyTM, Nicolas Ferreyros, managing director of policy, advocacy, and communications, Community Oncology Alliance, explained how biomarker testing is essential for tailoring modern cancer treatments, leading to better efficacy and reduced costs from ineffective therapies. The COA is actively advocating for supportive policies that ensure broad patient access and adequate reimbursement for community oncology practices.
“We need to ensure broad and equitable access to biomarker testing for cancer patients, and reduce barriers for that access so that they can get the right care and the right treatment that they need for their cancer,” explained Ferreyros in the interview.
Ferreyros also addressed the growing concern with physician autonomy due to interference from insurers and pharmacy benefit managers. The COA is calling for a return to an era where physicians' clinical judgment is respected, allowing them to provide the right care without unnecessary interference from entities not directly involved in patient treatment.
In the interview, Ferreyros discussed how both increased biomarker testing access and protected physician autonomy are central to the COA's efforts to optimize cancer care within community oncology settings.
Targeted Oncology: How does increased biomarker testing significantly impact community oncology practice and patient outcomes?
Ferreyros: I think what we are seeing is that biomarker testing really helps advance personalized cancer care. We are in an era of modern cancer treatments, where patients have access to groundbreaking therapies that are tailored to their unique situations and to their unique cancers. Ensuring that patients have access, and that includes easy access with low cost sharing or no cost sharing to biomarker testing, is critical to precision and personalized treatments. It improves outcomes by getting them the drugs that they need, when they need it, and where they need it, and cost efficiency, of course. We no longer provide treatments that are lower efficacy or less effective. There are a range of benefits that come with biomarker testing, the practices can be accessed.I think the whole point of the Community Oncology Alliance's position on biomarker testing and access to it is that we need to ensure more of our patients have access and easier time accessing these important treatments and tests.
What are the biggest challenges for community oncology and ensuring equal access to biomarker testing?
I think the biggest challenge with access to biomarker testing for patients is unequal access, meaning so much of your ability to get access to biomarker testing is determined by your insurance coverage and your policy documents. Our goal is to advance policy and support in both sorts of access for patients, the reimbursement structure, and availability of biomarker testing so that more patients, regardless of their insurance and their insurance status have access to this important tool.
How can biomarker results help community practices shorten treatment and reduce costs of ineffective therapies?
We are in a golden age of modern cancer treatments, where more and more treatments are tailored to very specific cancer types and patient scenarios, and having access to biomarker testing is critically important for being able to target those therapies and ensure that the right treatment goes to the right patient at the right time. We are no longer sort of flying blind and hoping that the treatment is going to work for that specific scenario. This is truly space-age medicine, and we have the tools to treat them, but biomarker testing is critical because it helps you understand, will that drug in that scenario help that patient? We are no longer seeing waste from unnecessary treatments. We no longer see ineffective treatments. We are helping patients get the medicine and the treatment that they need at the right time, and we are saving the system money. It is a win-win for everybody.
What key policy changes are needed to broaden biomarker testing in community oncology?
We need supportive policies that ensure biomarker testing access for patients full stop that is both on the patient side for their insurance coverage and ensuring that there's adequate and sort of low barrier access to biomarker testing for cancer patients. On the practice side, we need to ensure that there's adequate reimbursement, and that the bureaucracy and the friction that is often thrown up to access the treatments that come through biomarker testing are not in place. It is looking end to end at the system and ensuring that patients have access to this critically important testing so that then they can get the modern treatments that they need, when they need them, and where they need them.
What are the COA’s takeaways regarding biomarker testing?
Our position is that biomarker testing is an essential tool in modern cancer treatment, and it is pivotal in ensuring that patients have access to the latest and greatest cancer treatments that are available and targeted and tailored to them. We need to ensure that the entire system, from the payers to the providers to the diagnostics companies and the manufacturers, all are working in concert to ensure that patients are able to access this critically important tool.
What are the most harmful examples of insurer/pharmacy benefit manager [PBM] barriers to physician autonomy in community oncology settings?
With the rise of PBMs and insurers who are often one in the same these days, we see tremendous barriers for patients being able to access the treatments that they need. These barriers come in the form of things like step therapy, prior authorization, limited formularies, and what that is doing is getting between the patient and the physician and the treatment that they need. The Community Oncology Alliance is here making a call to let doctors be doctors and ensure physician autonomy is respected. These middlemen are not there seeing the patient, not treating the patient, they do not understand the patient's unique situation and scenarios, or their clinical situations. It is really the doctors who went to med school for a reason, and they swore a Hippocratic oath, and they are taking care of the patient, so ensuring physician autonomy and decision making is respected and trusted is critically important for the system.
How can community oncologists best advocate for their treatment decision autonomy?
I think advocacy from community oncology is critically important. We say this all the time. If you are not at the table, you are going to be on the menu. There are other people talking about you, about the issues that matter to you and your patients, and so you need to have a voice in this. Ensuring physician autonomy is just one of the many issues. Slowly but surely, middlemen, insurers and PBMs are working to erode physician autonomy and take more and more control of what happens in the treatment room, and so physicians need to be out there very loudly pointing out these challenges, pointing out the problems that happen with PBM interference, pointing out the challenges that come from insurer step therapy, prior authorization fail first, etc, policies that harm patients and ensuring that elected officials, regulators and other policymakers understand the harm that comes when physician autonomy and patient care is disrupted like that.
How do restrictive policies damage the physician and patient trust in community oncology?
It is an unfortunate side effect of the taking away of physician autonomy by middlemen, insurers and PBMs, where the patient-physician relationship is harmed. Oftentimes, the patient is in that room and does not understand why they are being denied a test or a treatment that they need for their disease or illness, and they are often looking right across the table at the person to blame, whether it is the doctor or the nurse or the practice staff, who just want to ensure that the patients can get the care that they need. The problem with all this is that we have put into the system and this taking away physician autonomy through all policies and regulations that slow down or interfere with patient care is that it slowly but surely has eroded trust in the system, and slowly but surely has eroded the patient care relationship.
What else should a community oncologist know regarding the COA’s position on biomarker testing and physician autonomy?
Biomarker testing is an essential and groundbreaking tool in modern cancer treatment. It ensures that patients receive the right care at the right time in the right place, and has the potential to reduce sort of unnecessary spending and side effects and toxicity from treatments that aren't necessarily working or that aren't the best for that patient. The key takeaway for this is that we need to ensure broad and equitable access to biomarker testing for cancer patients and reduce barriers for that access so that they can get the right care and the right treatment that they need for their cancer.
For physician autonomy, over the last couple of decades, physician autonomy has been slowly eroded by interference from middlemen, insurers, and pharmacy benefit managers that don't actually treat the patients. This has happened in a lot of ways, whether it is sort of restrictive coverage and formularies, step therapy, step edits and fail first policies, or other just sort of simple bureaucratic measures that have been put in between the physician's judgment and what they think the patient should be receiving. The key takeaway for this policy is that we want to get back to an era where we are protecting and letting doctors be doctors, using their clinical judgment and ensuring that their patients can receive the right treatment at the right time when they need it, without interference from those who are not in that exam room, who do not know their patients and are not treating them.
