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F or decades, the median survival of metastatic melanoma patients was less than 7 months, with only 15% of patients achieving 1-year survival, regardless of treatment. Ipilimumab is a fully human monoclonal antibody (mAb) that reverses tumor-induced immunosuppression by blocking the interaction of CTLA-4 with its ligands, CD80/CD86. Tis agent signifcantly improved survival in metastatic melanoma patients. Ipilimumab was approved by the US Food and Drug Administration (FDA) in 2011 for treatment of unresectable and metastatic melanoma. A recent update of long-term follow-up of ipilimumabtreated patients has demonstrated a survival plateau of 18%-22% between 3-10 years after treatment. Based on this data, we wanted to ofer ipilimumab therapy in our multiphysician oncology practice. Virtually none of the physicians in our practice had any prior experience with the agent. Only 1 of 34 physicians had extensive prior experience with the mAb, and was the major advocate. Te high drug purchase cost, and uncertainties about billing mechanisms and reimbursement were concerns within the practice. Insurance copayments from patients can also result in signifcant fnancial costs and duress to patients with cancer. In some cases, these represent as much as 20% of the purchase cost of the medication. We describe here the challenges and success of implementing ipilimumab therapy through careful planning and active involvement of medical, administrative, and support staf. Lessons learned from this process have subsequently been used in our practice to evaluate and implement other new, efective, and expensive medications.

the journal of community and supportive oncology

Implementation of ipilimumab therapy in a private practice oncology group: overcoming start-up and reimbursement issues related to expensive new cancer drugs