Two of the largest U.S. pharmacy benefit managers, Express Scripts and CVS Health, set in motion a new approach to drug reimbursement by introducing indication-specific pricing (ISP). Instead of reimbursing a drug the same way across all indications for which it is approved, the PBMs have set up programs to vary reimbursement and formulary placement of some drugs based on their clinical value in different indications or patient subpopulations. This study examines the potential for this strategy to take hold with U.S. managed care organizations’ coverage of oncology drugs. Payers are surveyed about the potential for using an ISP strategy with drugs to treat renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC), while oncologists are queried on their receptivity to this game-changing strategy.


  • What is the current access and prescribing landscape for RCC and HCC as new label expansions create more treatment alternatives?
  • What is the future for ISP in oncology and are MCOs employing this strategy now?
  • What are or will be the major challenges to varying pricing and/or coverage by indication and how do/will MCOs track diagnosis to implement ISP?
  • Do oncologists ever encounter situations where the drugs they prescribe are covered differently by indication, and what is their reaction to this trend?

PRODUCT DESCRIPTION Access & Reimbursement: Provides in-depth insight regarding the impact of payer policy on physician prescribing behavior so you can build your market access strategy and optimize your brand positioning.

Table of contents

  • Potential for Indication-Specific Pricing in Oncology: Renal Cell Carcinoma & Hepatocellular Carcinoma (US)
    • U.S. A&R: Potential for Indication-Specific Pricing in Oncology: Renal Cell Carcinoma & Hepatocellular Carcinoma

Author(s): Paula Wade

Paula Wade tracks and analyses the national trends in the health insurance industry for Decision Resources Group. She produces the company’s Managed Care Organization Analyzer products and has authored several of DRG’s Physician Payer Dynamics reports. A former newspaper journalist with a background in survey research, Ms. Wade has also worked in healthcare advocacy and for the Tennessee Department of Commerce and Insurance.

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