Skip to main content

Trapelo Health, Magellan Hope to Ease Prior Authorization for Precision Oncology Testing

Premium
This article has been updated to correct the location of Magellan Health's headquarters.

CHICAGO – The recently announced partnership between Trapelo Health and the Magellan Rx Management pharmacy benefits management arm of Magellan Health promises to make value-based oncology care more accessible by closing an important part of the treatment loop: insurance authorization and payment for biomarker-guided cancer therapy.

Last week, the companies announced plans to bundle their technologies to support this process.

Trapelo, of Burlington, Massachusetts, makes a clinical decision support system that links healthcare providers, testing laboratories, and payors, giving them access to molecular testing information, ordering, and results interpretation in order to optimize utilization of molecular testing services and offer the most appropriate care to patients.

The technology relies on an evidence-based framework to capture and codify results of clinical research as it becomes available, informing which biomarkers are appropriate and should be tested for each patient. The system also aligns patients' cancer diagnoses, molecular test results, national guidelines, US Food and Drug Administration indications, and payors' policies to provide clinicians with an overview of treatment options.

The platform can manage a wide range of molecular tests including next-generation sequencing panels, single-gene tests, cytogenetics, immunohistochemistry screening, and fluorescence in situ hybridization.

Magellan Rx Management, a division of Phoenix-based Magellan Health, provides oncology management services on behalf of payors to address issues including prior authorization, customized formulary management, personalized dosing, patient care management, and post-service claim edits.

Magellan Rx is a specialty PBM, with a particular focus on oncology. The firm conducts prior authorization on behalf of its payor partners. PBMs have long had an interest in making sure that patients get the most appropriate treatments while staying within the confines of payer formularies that often incentivize lower-cost options. Pharmacogenomics and other biomarker-driven processes can guide providers and PBMs to the right treatments.

"A lot of the oncology therapies that are coming out are really targeted therapies that require pharmacogenomics prior to even getting the therapy," said Haita Makanji, VP of clinical strategy and innovation at Magellan Rx Management.

The PBM works with providers to get tests ordered, receive and analyze the results, and then get insurance authorization to cover the appropriate drug, she explained. Trapelo will be providing the analysis and managing the order workflow.

Magellan Rx also works with health plans to gain prior authorization for lab tests.

"Our goal is to support providers and their patients in getting the best care possible and ensuring that that care is evidence-based," Makanji said. "The partnership with Trapelo not only supports the right type of patient care, but also eases administrative burden."

The relationship between physicians and payors has always had at least a hint of contention, and prior authorizations often are sore points for providers who want to get their patients into treatment as quickly as possible following a diagnosis as serious as cancer.

Caroline Carney, CMO of Magellan Health and Magellan Rx Management, said that her company cuts out steps of the oncologist having to go to a health plan for prior authorization, then taking that authorization to a PBM or specialty pharmaceutical company. In concert with Trapelo, the company now will be able to provide precision guidance for test and treatment orders.

"We think it's critically important that you don't rush into treatment, that you get the treatment right," Carney said. "The right treatment in many oncology cases will be based on what those genetic findings tell us."

Carney said that the addition of Trapelo's software to Magellan's drug review process will shorten authorization time.

Makanji said that this will lessen the administrative burden on care providers by bringing lab ordering, results delivery, clinical decision support, drug ordering, and payor authorization into a single portal.

Trapelo is helping Magellan create a single sign-on for all the IT systems involved in these processes, just as the bioinformatics company has done with other partners.

Trapelo Health CEO Clynt Taylor said that the partnership will help expedite the process of obtaining payor authorization.

He said sometimes practices will have their own labs or physicians with good enough relationships with outside labs that they can be confident moving forward with a test before obtaining authorization.

When they do have to seek prior authorization, Trapelo can get an answer "virtually instantly" when working with a partner insurance company, according to Taylor.

Trapelo can display "fast-path" options that meet requirements for prior authorization with a specific payor. While that may not guarantee that the test will be authorized, it gives the doctor a good idea, Taylor said.

This kind of service means that Trapelo has to keep on top of prior-authorization rules for each payor it contracts with. "If we don't have a relationship with the payor, but we do have a relationship with the practice, then we can at least load into Trapelo that publicly available information about which labs are in network," Taylor said.

Trapelo has integrated its system into laboratory information systems including Care Evolve and Orchard Software's Copia and is in the process of linking with electronic health records. Taylor said he was unable to disclose names of EHR vendors the company is working with because the integrations are not live yet.

Where integrations are complete, Trapelo imports the information from its platform into the LIS through a single sign-on. The physician still needs to answer some questions from Trapelo about the type and stage of cancer and whether it is metastatic.

"We might ask [about] any prior therapies and prior testing, and whether the patient is open to a clinical trial," Taylor said.

Trapelo then lists biomarkers associated with the suspected cancer that the patient should get tested for in order to determine the best path of treatment, and provides names of labs that can perform a specific test. Each practice can customize lists of biomarkers to help with trial recruitment. The system then can facilitate electronic order entry if it is tied to the LIS or EHR.

"They now have the assurance that they've placed an order that did not miss testing for those biomarkers that should be tested, and we made sure that it was routed to their preferred lab," Taylor said.

The prior authorization, including a check for fast-path approval, can happen from within the EHR or LIS as well if the patient's health plan is in the Trapelo system.

"We think that it's going to give us an opportunity to help a lot of oncologists and payors shorten the gap and the confusion that can happen when you're wanting to place an order for a test," Taylor said.

If the lab is in-network for the payor, the order shows up with the lab at the same time the payor sees it.

"By closing that gap in real time, we can shorten the time it takes to process the prior authorization," Taylor said. "That's a big plus, we think, for patients as well," because the automation ultimately can shorten time to treatment following a diagnosis.

Trapelo has what the company calls an "actionable dashboard" that lists therapeutic options and clinical trials.

The partners have not settled on a timeline for rolling out the combined offering. Makanji said that the hope is to start a pilot this year with a still-to-be-determined payor customer of Magellan.

Magellan currently has a home-grown technology platform for providers to log into to request prior authorization for both medications dispensed via retail pharmacies and drugs administered in the clinic or hospital. Payor policies and formularies are already embedded into that platform.

"Once that provider gets their testing order results, we're going to be able to customize the platform to be able to say this drug in oncology might be better for the patient based on their biomarker results," Makanji said.

Carney said that the company's eventual goal is to offer the technology to all of its oncology customers, and perhaps also for other indications as the use of cell and gene therapies grows.

"We are looking to expand beyond the pilot once we have the process flows all worked out to ensure [a] seamless process for the providers," she said.

"It is critically important for us to help providers get it right in this space, because the science is so rapidly evolving," Carney said. "Not only the technology that [Trapelo brings], but their bench strength in understanding and keeping abreast of that rapidly changing science is critical to this partnership."

Carney acknowledged that precision prescribing is largely confined to cancer and rare diseases today, but said that it should grow rapidly in the future, so Magellan will need to keep up with the coming expansion.

The combined product will be available in the US only, Carney said, given the unique nature of the country's healthcare industry. 

Both firms in the partnership are in the midst of big changes, namely acquisitions. Health insurer Centene announced Jan. 4 that it had purchased Magellan Rx Management parent company Magellan Health for $2.2 billion.

Trapelo was acquired March 24 by cancer diagnostics company NeoGenomics Laboratories for $65 million, consisting of $35 million in cash on hand and $30 million in NeoGenomics' common stock.

Fort Myers, Florida-based NeoGenomics will offer Trapelo's clinical decision support system to providers, payors, and labs to aid precision oncology across all healthcare settings.

Taylor called the acquisition a "real positive thing for us" because NeoGenomics covers so many hospitals. He said that the parent company provides more than 1 million molecular tests a year and has contracts with about 150 payors.

Even before the deal, NeoGenomics was one of the labs Trapelo had been working with.

Taylor said that NeoGenomics will run Trapelo as a wholly owned subsidiary, with few changes to day-to-day operations. NeoGenomics will have limited control so that Trapelo will be "lab agnostic" for its customers, with decisions based wholly on whether the lab can perform the test ordered and has a contract with the payor in question.

"That allows us to continue to work on behalf of payors and providers to facilitate those lab relationships they already have and prefer," Taylor said.

Since the acquisition, the bioinformatics company has drafted a new data-use agreement for all of its lab partners that "draws a firewall between Trapelo and the NeoGenomics lab" so that customers can be confident that recommendations are being made fairly and that information is not being shared with anyone who does not need to see it, according to Taylor.