Confidential and Proprietary Copyright © 2014 McKesson Specialty Health. All rights reserved. 3/31/2015

Pathways Task Force Subcommittee

Mission Statement: The mission of Value Pathways powered by NCCNTM/Level I Pathways is to

facilitate the delivery of high quality, high value cancer care to our patients through a physician-

driven network-supported program utilizing evidence based medicine.

I. PURPOSE A. The purpose of this document is to outline the stakeholders, processes and expectations for

developing and maintaining clinical, evidence-based medicine pathways (Level I Pathways and Value Pathways powered by NCCNTM) that are governed by The US Oncology Network’s Pathways Task Force (PTF).

II. DEFINITIONS

A. Pathways Task Force (PTF) 1. The PTF is a sub-committee of the US Oncology Network P&T committee which governs

the development and maintenance of The US Oncology Network’s Level I Pathways/Value Pathways powered by NCCNTM.

2. The PTF advises and makes recommendations to the P&T Committee and The US Oncology Network for incorporation of evidence-based, cost-effective treatment to include on Level I Pathways/Value Pathways which supports:

i. The use of clinical trials ii. Evidence-based data for specific cancer types based on disease and patient-specific

characteristics iii. Cost effective systemic treatment iv. Continuous monitoring and analysis of results and outcomes.

B. Value Pathways powered by NCCNTM 1. Joint evidence and value-based treatment guidelines developed and maintained by

The US Oncology PTF in collaboration with designated NCCN Guideline disease committee members.

2. Value Pathways powered by NCCNTM are a subset of the NCCN Disease Guidelines. 3. Technology Platforms

a. iKnowMed (iKM): An electronic health record which is utilized by, but not restricted to, participating US Oncology Network practices.

b. Clear Value PlusSM (CVP): the decision support tool that delivers Value Pathways powered by NCCNTM and NCCN Disease Guideline content to practices by interfacing with contracted EHR’s.

Confidential and Proprietary Copyright © 2014 McKesson Specialty Health. All rights reserved. 3/31/2015

V. Voting Members (appendix A):

1. Each pathway (PW) will have a corresponding Disease Chair who will oversee development and maintenance of said PW. Each Disease Chair is a voting member of the PTF

2. Voting members of the PTF within The US Oncology Network are appointed by the P&T Committee Chairman, McKesson Specialty Health Chief Medical Officer and the PTF Chairman.

3. Terms of membership will be reviewed by the PTF Chair annually. 4. NCCN will appoint 3 physician members for each Pathway as voting members to be

involved in the review and incorporation of data into Value Pathways development and update. The physicians will be existing members of the NCCN Guideline Panel for the disease.

VI. PTF MEETINGS:

5. PTF meetings will take place monthly or as determined by the PTF Chair. 6. Semi-annual P&T meetings may include in-person meetings.

A. Pathway Maintenance – General Guidelines

1. A process for reviewing and updating Pathways will be followed. 2. Evidence to be considered for Pathways will be reviewed during monthly PTF calls. 3. Each Pathway will be reviewed for updates/changes at least once per year. Reviews will

include, but are not limited to: a. Evidence Tables for any regimens to be considered for addition to Pathways b. Cost evaluation (cost to payer and pt is evaluated)

B. External Pharmacoeconomic Submissions

1. External submissions based on pharmacoeconomic data may be accepted for PTF review. a. All submissions will be published on-line in accordance with guidelines from the MSH

website (https://oncology.mckessonspecialtyhealth.com/clinical-tools/value-pathways) 2. A summary of PTF discussion and aggregated votes will be included for display on the MSH

website along with the original submission documents once P&T voting is complete a. The final PTF decision is communicated to the submitter within 120 days from

complete submission.

Confidential and Proprietary Copyright © 2014 McKesson Specialty Health. All rights reserved. 3/31/2015

Appendix A.

PTF Physician Composition and Appointment 2014

PTF Chairman

Marcus Neubauer, MD – PTF Chairman, Medical Officer i. Non-voting position

Voting members:

Alex Spira, MD- Lung/H&N Cancer Chair: VA

Lalan Wilfong, MD- Supportive Care: TX

David Andorsky, MD- Hematology Chair (MM, leukemia): CO

John Burke, MD- Hematology Chair (Lymphoma): CO

Tom Cartwright, MD- GI Cancer Chair (Colon/Rectal): FL

Debra Patt, MD, MPH- Breast Cancer Chair: TX

Nick Robert, MD- Breast Co-Chair: VA

Ian Schnadig, MD- GU Cancer Chair: OR

Mark Sitarik, MD- EHR Medical Director: CO

Russ Hoverman, MD, PhD-Advance Care Planning Chair: TX

Ellen Smith, MD- Gynecologic Oncology Chair: TX

Andrew Scott Paulson, MD- GI Cancer Chair (Pancreas, GE): TX PTF Subcommittee Members: (non-voting)

Neelima Denduluri, MD: VA

Will Winter, MD: OR

Kartik Konduri, MD: TX

Tim Larson, MD: MN

Participating NCCN Disease Panel Members

BBreast:

William J. Gradishar, MD: Northwestern University

Ben Anderson, MD: University of Washington (SCCA)

John Ward, MD: University of UT

CML:

Susan O’Brien, MD: MD Anderson Cancer Center

Jerald P. Radich, MD: Fred Hutchinson Cancer Research Center

Neil Shah, MD: UCSF CColon/Rectal:

Al B. Benson, MD: Northwestern University

Alan P. Venook, MD: UCSF

Confidential and Proprietary Copyright © 2014 McKesson Specialty Health. All rights reserved. 3/31/2015

Christopher G. Willett, MD: Duke University

N Head and Neck Cancer:

David G. Pfister, MD: Memorial Slone Kettering Cancer Center

(MSKCC)

Sharon Spencer, MD: UABMC

Jill Gilbert, MD: Vanderbilt University

NNSCLC:

David S. Ettinger, MD: Johns Hopkins

Renato Martins, MD, MPH: University of Washington (SCCA)

Doug E. Wood, MD: University of Washington (SCCA) PProstate:

Philip W. Kantoff, MD: Dana Farber Cancer Institute

James L. Mohler, MD: Roswell Park Cancer Institute

Sandy Srinivas, MD: Stanford University

Multiple Myeloma:

Kenneth Anderson, MD: Dana Farber Cancer Institute

William Bensinger, MD: Fred Hutchinson Cancer Research Center

Cristina Gasparetto, MD: Duke University

Non-Hodgkin’s Lymphoma/CLL:

Leo Gordon, MD: Northwestern University

Andrew Zelenetz, MD: Memorial Slone Kettering Cancer Center (MSKCC)

Ovarian:

Robert Morgan, MD: City of Hope

Deborah K. Armstrong, MD: Johns Hopkins

Carolyn Johnston, MD: University of Michigan Pancreas:

Margaret Tempero, MD: UCSG

Mokenge Malafa, MD: Moffitt Cancer Center

Steven Cohen, MD: Fox Chase Cancer Center

SCLC:

Gregory Kalemkerian, MD: University of Michigan

Billy W. Loo, Jr., MD, PhD: Stanford University

Wallace Akerley, MD: University of Utah