Highlights

• Expensive oncology treatments [PD-1 and upcoming CAR-T therapies] will continue to be covered by large insurers formularies, but access will be restricted according to NCCN guidelines.
• Sustainability of healthcare costs is a big question and will be largely dependent on government actions as with recent turn from fee for service to episode of care.
• Very large insurers care about long-term cost-savings of curative treatments, but most commercial plans are only looking a year down the road.
• PCSK9 drugs may be a coverage concern if in statin failure indication, but coverage would likely be highly managed.
• The methodology of this large insurer will not change substantially in response to the lessons learned from Hepatitis C drugs.

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Disease Group Covered:

Cardiovascular
Oncology