Problem Statement: Barriers to access to new health technologies in Oncology are not limited to budget issues, a shared decision-making guided by evidence-based medicine plus health economics can improve patients’ access and prevent inequities, such as judicialization.

Description: In line with the 2022-2023 Top 10 HEOR Trends established by ISPOR, Oncoclínicas Group, which is the Brazilian largest private healthcare provider in Oncology, has developed a Medical Access Support Project. In this initiative, a group of specialists receive and analyze all cases with potential barriers to access before sending the claim to the private health insurance. Theses experts review each individual case and raise not only evidence-based medicine data, but also the magnitude of clinical benefit, precision oncology issues, as well as health economics. After this deep analysis, the best individualized management is established for each individual case and, subsequently, there is a roundtable discussion for the shared decision-making between the payer, the health care provider, and also the patient's health care team.

Lessons Learned: The program was established in May 2022. The average time for the first response is 1.72 days and the average time for completing the review process is 2.15 days. The Medical Access Support Project has analyzed 238 cases with regulatory constraints (of which 171 were high-cost regimens) and achieved a rate of treatment authorization of 64% (61% of approval among high-cost regimens). Moreover, considering the 36% of cases in which there was a negative response from the payer, only 6% went to the court. Real-world evidence studies are foreseen in the future of the project.

Stakeholder perspective: Payer, provider, and industry.