Table of Contens

5 EXECUTIVE SUMMARY
5 The growing need for better management of oncology costs
5 Overview of oncology clinical pathway programs
6 The impact of pathways on oncology
6 Oncology pathways and pharma
7 Future of oncology pathways
9 MANAGEMENT OF ONCOLOGY COSTS
9 As oncology spending grows, so does payers’ use of utilization controls
11 Clinical pathways – what, who, and where?
13 Bibliography
16 ONCOLOGY CLINICAL PATHWAY PROGRAMS AND DEVELOPERS
16 Oncology pathway developers
21 Design and structure of pathways
30 Bibliography
34 THE IMPACT OF PATHWAYS ON ONCOLOGY
34 A minority of US payers have implemented oncology pathways, but many expect use to
increase
35 Research and company-reported data suggest that pathways help standardize treatment and
save money in oncology
38 Drivers and resistors to the use of oncology pathways from different stakeholder perspectives
44 The place of pathways in the changing oncology payment landscape
47 Bibliography
50 ONCOLOGY PATHWAYS AND PHARMA
50 Remember that the pathway’s first step is in the clinical development program
51 Oncology pathway inclusion will increasingly hinge on available biomarkers
51 Open the transparency dialog with third-party pathway vendors
52 Off-pathway and “ahead-of-pathway” messaging can drive success at the margins
53 Recognize that oncology pathways could be protective for novel, high-priced therapies
53 Bibliography
54 FUTURE OF ONCOLOGY PATHWAYS
54 Fragmentation or consolidation: the jury is still out
55 The limited role of patients could be expanding
56 Oncology medical societies will help drive pathways to progress in the private and potentially
the public sector
57 Pathways will enter public sector payment models as components of larger APMs
58 “Big data” in medicine: help or harm for pathways?
59 Bibliography

LIST OF FIGURES

7 Figure 1: Summary of the impact of oncology pathway use on pharma and strategic
recommendations
9 Figure 2: US oncology drug sales, 2012–23
10 Figure 3: Specificities of cancer management contributing to high overall costs of care
11 Figure 4: Characteristics of clinical pathways
13 Figure 5: Drivers of clinical pathway use in oncology
16 Figure 6: Algorithm for decision-making in pathways development
17 Figure 7: Oncology pathway developers in the US
23 Figure 8: Oncology clinical pathway vendor models
24 Figure 9: Oncology pathway vendor models – benefits and risks to key stakeholders
26 Figure 10: Potential change in total and component costs of cancer care with pathway-based
incentives
34 Figure 11: Penetration of pathway developers – number of states covered in provider or payer
collaborations
36 Figure 12: Average annual per-patient savings from on-pathway oncology treatment
37 Figure 13: Impact of oncology pathways on oncology drug use
38 Figure 14: Drivers and resistors to increasing use of clinical pathways linked to oncology
treatment payments in the US
42 Figure 15: Payers’ perceived barriers to adoption of pathway-based payment programs
45 Figure 16: Clinical pathways and the spectrum of alternative payment methods in oncology
50 Figure 17: Oncology pathways: summary of recommendations for pharma industry
54 Figure 18: Future trends in the oncology pathways space and their impact on pharma
companies

LIST OF TABLES
19 Table 1: Third-party oncology pathway vendors in the US
21 Table 2: Tumor types included in oncology clinical pathways from select vendors and payers
28 Table 3: Examples of payer–provider link ups involving oncology pathways