The high number of premium-priced non-small-cell lung cancer (NSCLC) therapies and the large number of NSCLC patients have resulted in a significant financial burden for payers. Costs are set to increase with the expected label expansion of currently approved epidermal growth factor receptor(EGFR) and immune checkpoint inhibitors and the continued first-line uptake of AstraZeneca’s Tagrisso and Roche’s Alecensa. To control the rising costs of NSCLC treatment, payers use extensive utilization management strategies. Presenting data from surveys of 31 managed care organizations (MCOs) and 100 oncologists, this access and reimbursement report analyzes the reimbursement environment for 19 of the major therapies for metastatic NSCLC. In addition, it examines 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 make formulary inclusion decisions about new NSCLC drugs? What are the pricing and reimbursement drivers and constraints for NSCLC drugs?
  • What is the coverage status of the major NSCLC drugs, and what are the key drivers behind their status? What changes do payers plan for the future?
  • What utilization management strategies do payers use to control the cost of NSCLC agents? How do they assess the impact of cost and efficacy on the formulary placement of new and existing NSCLC therapies?
  • How do physicians prescribe existing NSCLC therapies? What restrictions and clinical and nonclinical drivers must they consider, and what is the dynamic interplay between them?

PRODUCT DESCRIPTION

U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.

Market covered: United States.

Primary research:

  • Survey of 100 medical oncologists in the United States.
  • Survey of 31 U.S. MCO pharmacy and medical directors (PDs/MDs).

Key drugs covered: Opdivo, Keytruda, Tecentriq, Imfinzi, Alimta, Avastin, Abraxane, Cyramza, Alecensa, Xalkori, Zykadia, Alunbrig, Lorbrena, Rozlytrek, Tagrisso, Tarceva, Gilotrif, Iressa, Vizimpro.

Table of contents

  • Detailed, Expanded Analysis (US)
    • Access & Reimbursement Non-Small-Cell Lung Cancer -US June 2020

Author(s): Ananya Sadhu, Ph.D; Chris Lewis

Ananya Sadhu, is an analyst with the oncology team at Decision Resources Group with expertise in multiple oncology indications including pancreatic cancer. Prior to joining Decision Resources Group, Dr. Ananya Sadhu was a postdoctoral fellow at National Centre of Biological Sciences, Bangalore, where she studied the role of chromatin architecture in regulating gene expression in breast cancer. Ananya holds a in Molecular Biology from National Institute of Immunology, New Delhi. She also worked as a Scientific Officer with Arvind Remedies Ltd., a pharmaceutical company, where she coordinated various stages of non-clinical / clinical research activities for drug development of a patented polyherbal formulation.

Chris Lewis serves as primary research manager, Access and Reimbursement, with responsibility for coordination, content review and content generation of the market access and reimbursement insights at DRG. Content is based on online surveys of managed care organizations and physicians and expert analysis of reimbursement and prescribing patterns of key therapies treating various disease states. Lewis was an analyst/senior analyst for the group’s HealthLeaders-InterStudy subsidiary for eight years, specializing in the managed care and pharmacy benefit management industries. Throughout her tenure, she has produced the Health Plan Analysis reports for California, New York, New Jersey, Connecticut, and Pennsylvania and authored DRG’s series of pharmacy benefit manager profiles. She has also conducted numerous webinars for the group. She is a seasoned journalist with a in communications from California State University, Sacramento.


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