The high number of premium-priced NSCLC therapies and the large number of NSCLC patients result in significant financial burden for payers. These costs are set to increase with the approval of additional therapies, such as AstraZeneca’s Imfinzi for unresectable stage III NSCLC, and with label expansions of existing treatments, such as AstraZeneca’s Tagrisso in first-line EGFR-mutation-positive NSCLC. To control the rising costs of NSCLC treatment, payers employ extensive utilization management strategies. Presenting data from surveys of 31 MCOs and 102 oncologists, this access and reimbursement content analyzes the reimbursement environment for eight of the major new therapies for metastatic NSCLC, and how MCO formulary decisions and utilization controls on both the pharmacy benefit and medical benefit affect prescribing by surveyed oncologists.

Questions Answered

  • How do MCOs undergo formulary inclusion decisions upon new NSCLC drug launches? What are the P&R drivers and constraints for NSCLC drugs?
  • What is the coverage status of the major NSCLC drugs and what are the key drivers behind these decisions? What changes are planned for the future?
  • What utilization management strategies are employed by payers to control the cost of NSCLC agents? How do they assess the cost and efficacy impact of new and existing NSCLC therapies?
  • How do physicians prescribe existing NSCLC therapies? What are their restrictions, as well as the clinical and nonclinical drivers for their decisions, and what is the dynamic interplay between them?

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.

Markets covered: United States

Primary research:

  • Survey of 102 medical oncologists in the United States.
  • Survey of 31 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).

Key drugs covered: Opdivo, Keytruda, Tecentriq, Imfinzi, Alecensa, Xalkori, Tagrisso, Tarceva.

Table of contents

  • Detailed, Expanded Analysis (US)
    • Access & Reimbursement - NSCLC U.S. [December 2018]

Author(s): Priti Girotra, M.Pharm., Ph.D

Priti Girotra, , is an analyst in the oncology team at Decision Resources Group and has authored insightful content on multiple indications including Non-Small-Cell Lung Cancer, Colorectal Cancer, Gastroesophageal Cancer, Malignant Melanoma, and Multiple Myeloma. Prior to joining DRG, Dr. Girotra conducted her research on formulation optimization of nanoparticles containing triptan derivatives for effective brain targeting and therapeutic management of migraine, under a DST-INSPIRE Fellowship at University of Science & Technology, Hisar, India.


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