NEW YORK – CVS Health announced last month that it was launching a precision oncology program in partnership with tech company Tempus aiming to facilitate the use of genomic testing in line with guidelines and ease reimbursement headaches that oncologists and patients have had to face.
Within this program, called Transform Oncology Care, oncologists will be able to access Tempus' multi-gene panel tests for advanced cancer patients through a web-based portal that's part of the e-prescribing workflow. Based on the test results identifying targetable molecular markers, providers can prescribe marketed drugs that may benefit patients based on the available evidence and guidelines or find clinical trials studying experimental therapies in individuals with those markers.
CVS's goal in launching this program is twofold: to improve cancer patients' outcomes and lower costs. "We've heard from our payor clients that oncology spend[ing] is one of their top concerns. Our program helps to address specific pain points we have heard from our clients," a CVS spokesperson said in an email statement.
CVS made its move as retailers like Amazon, Walmart and Walgreens are making strides in disrupting traditional healthcare delivery.
"We're in the middle of a technology paradigm shift," said Patricia Deverka. "We have all this data: radiologic data, molecular data, phenotypic data, [but] … people are struggling with how you get ahead of the curve so you can actually utilize this data clinically at scale." Deverka is the director of value evidence and outcomes at Geisinger National Precision Health, where she assesses the value of personalized medicine strategies within health plans and systems.
"That's where companies like Tempus have found an edge where they are going to do the heavy lifting of cleaning, structuring, annotating the data and making it easier for oncologists to make good clinical decisions," she added."This is one of the medical specialties that is the most hit with information overload."
The increased use of multi-gene panels in personalizing care, much of it in oncology, has been a particular point of concern for payors, which have seen their spending on genetic testing increase in recent years. A number of payors have implemented prior authorization programs for genetic tests, which in turn, have increased coverage denials and added administrative headaches for providers.
CVS is aiming to ease this friction within its program by making it easier to align care with expert guidelines. "Therapeutic regimens that align to [National Comprehensive Cancer Network] guidelines, including those matched with the results of the broad-panel gene sequencing tests, will automatically receive prior authorization approval, speeding time to start of the therapy for patients," CVS Health said in a statement announcing the launch of the Transform Oncology Care program and its partnership with Tempus.
"While broad-panel gene sequencing tests can be expensive, they also help to avoid unnecessary spending by payors and patients on treatments that simply don’t work," the CVS spokesperson said. "That said, we aim to have insurers cover these tests when clinically appropriate for patients, as our strategy can help offset those costs over time through more efficient cancer care spending."
Time is critical when deciding how to treat advanced cancer patients, and studies have shown that cancer patients are missing out on the chance to receive molecularly guided treatments because they are too sick to receive treatment or they succumbed to their disease before test results or the drug are available.
"One of the biggest stumbling blocks to advancing precision oncology is so many people are not enrolled in clinical trials," Deverka said. "We typically lose outcomes data from people that are treated in routine practice. But if you start to take advantage of these new data platforms that are being built, you can use real world data and you can follow patients."
Additionally, she anticipates coverage decisions will evolve with technology advancements. For example, next-generation sequencing tests, like FoundationOne CDx, are being covered by Medicare and commercial payors, especially when platforms are approved by the US Food and Drug Administration. Payors also track the National Comprehensive Cancer Network's guidelines, which increasingly recommend evidence-based use of NGS panels to inform treatment.
"Over time, more of these [tests] will be paid for, as demonstrated by current trends towards increasing coverage," Deverka said. What's missing is sufficient data showing that molecularly matched treatments are improving patient outcomes. This is where the CVS-Tempus collaboration can help, she noted.
Tempus offers a 648-gene panel called Tempus xT and whole exome sequencing called Tempus XE, but it also provides transcriptomic and tumor/normal analysis with each sample. Additionally, the firm earlier this year launched the Tempus Integrated Molecular Evaluation (TIME) Trial, which promises to match patients in real-time to clinical trials based on the molecular features of their cancer.
Outside of the CVS collaboration, Tempus is working with several academic and cancer centers around the US, as well as the American Society of Clinical Oncology. In September, Tempus published a retrospective analysis in Nature Biotechnology which showed their Tempus xT platform had the ability to match more than 40 percent of patients to a targeted treatment and about three quarters to a clinical trial, a higher rate than what they estimated would be possible with tumor-only DNA panel testing.
Patients who receive genetic testing through CVS Health's precision medicine program can have Tempus run through their results, determine eligibility, and recommend local clinical trials that they can then opt to enroll in. The program will also integrate nurse-led care management into payors' existing programs.
In the future, CVS Health plans to expand the services offered within the program, including efforts aimed at improving local access to screenings and prevention services offered at CVS HealthHUBs, as well as CVS pharmacy and MinuteClinic locations.
A CVS spokesperson said that the MinuteClinics already offer Human Papillomavirus and Hepatitis B vaccination services and tobacco-cessation programs, and in the future, additional cancer screening and management services will be added at CVS Pharmacy, at MinuteClinics and CVS's new HealthHUB locations. The program will use CVS’s local data collection points and integrated systems to help better identify and intervene with patients who could benefit from preventive or screening services.
The precision medicine strategy within the Transform Oncology Care program is now available to all health plans, regardless of whether the payor is a current CVS Health PBM client. Aetna, which was acquired by CVS in November 2018, has adopted the new precision medicine component of 'Transform Oncology Care' for fully insured commercial populations and is rolling it out to participating Aetna provider networks in a dozen states.
According to CVS, the program also allows payors the option to adopt value-based contracts that will encourage on-label prescribing and expand access to novel therapies.
"Through Aetna, [CVS will] have access to the electronic health record data, the claims data, and they can hopefully get a greater number of people tested, a greater number of people matched to therapies," Deverka said. "The other piece that's missing is just to follow them over time and actually see did they respond or not."