Novologix (NLX) is a web-based clinical decision support prior authorization (PA) tool that is designed to reduce administrative burden and elevate quality of care by providing treatment approval at the regimen level instead of at the drug level, and incorporates evidence-based guidelines via a partnership with the National Comprehensive Cancer Network (NCCN). The current study sought to (1) evaluate the concordance of NLX-submitted PAs with NCCN-recommended regimens, and (2) estimate total cost of care for Medicare Advantage (MA) patients with non–small-cell lung cancer (NSCLC) who received NCCN-concordant versus NCCN-nonconcordant therapies.
MA patients diagnosed with NSCLC were included in this study. PAs were submitted via NLX and approval mostly took place in real time; those not automatically approved were deemed concordant after peer-to-peer consultations that led to NCCN concordance. To estimate total cost of care, MA patients actively being treated for NSCLC were identified from January 2020 to June 2020 using pharmacy and medical claims data, and NCCN concordance was determined, defined as concordance when the entire prescribed treatment regimen matched an NCCN regimen; patients not receiving an NCCN-recommended regimen were deemed to be nonconcordant. Patients were followed for 270 days after first-line treatment; total cost of care between concordant and nonconcordant patients at 30 days, 180 days, and 270 days was determined.
A total of 279 PAs were submitted via NLX and approved; of these, 83% were automatically approved in real time, the rest were deemed concordant after peer-to-peer consultations. To estimate total cost of care, 2690 MA patients were identified and followed; of these, 2166 (81%) patients were found to be NCCN concordant. Post-matching data for a 30-day follow-up period showed that the total cost of care was significantly lower for concordant patients (average, $20,200) compared with nonconcordant patients (average, $26,600), for a total cost-savings of $6400 per patient (P <.001). At longer follow-up (180 days and 270 days), a statistically significant 30% reduction in total cost of care was reported for NCCN-concordant patients.
Based on these results, the authors recommend that oncology practices engage in enhanced payer–provider collaboration and implement an automated regimen-level precertification process with real-time NCCN updates to facilitate lower cost and more efficient oncology care.
Source: Yeon H, et al. J Clin Oncol. 2021;39(suppl 15):Abstract 1522.