Seven premium-priced therapies (Avastin, Erbitux, Vectibix, Zaltrap, Stivarga, Lonsurf, and Cyramza) and three immune checkpoint inhibitors (Keytruda, Opdivo, and Yervoy) are FDA-approved to treat metastatic colorectal cancer, giving oncologists many treatment options and payers the leverage to control pricing through tiering and restrictions policies. Oncologists are seeking to optimize the sequencing of these therapies in a way that leads to the best outcome for patients while working within the constraints of their patients’ commercial and Medicare insurance policies. Label expansions of current therapies are expected to introduce more high-priced therapies to this market. Therefore, understanding the market access drivers that are important to payers and oncologists will be essential to maximize the uptake of these therapies.
- What role do key branded drugs play in the treatment of metastatic colorectal cancer, and how do payer restrictions affect oncologists’ prescribing practices?
- How widespread is the use of clinical pathways among MCOs and oncologists, and what determines a drug’s inclusion in these detailed treatment protocols?
- How do MCOs’ largest fully insured commercial plans and Medicare Advantage plans cover drugs for metastatic colorectal cancer, and what factors encourage favorable positioning of a drug on formulary?
- What are physicians’ and payers’ views on the future of novel, premium-priced therapies for metastatic colorectal cancer? How would they affect the uptake of current agents, and what measures are likely to control the rising cost of treatment?
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.
Primary Research Survey of 100 medical oncologists in the United States Survey of 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs / MDs).
Fingertip Formulary coverage and restrictions data for colorectal cancer therapies by commercial plans covering approximately 166 million lives nationally and Medicare Advantage Part D plans covering 14 million lives.
Key Drugs Covered: Keytruda, Opdivo, Yervoy, Erbitux, Avastin, Zaltrap, Vectibix, Stivarga, Cyramza, Lonsurf
- Detailed, Expanded Analysis (US)
- Access and Reimbursement Colorectal Cancer US May 2020
Author(s): Snigdha Gupta, Ph.D; Laura Vinuesa, DVM, MSc; Chris Lewis
Dr. Snigdha Gupta is a Lead Analyst in the oncology team at Decision Resources Group with expertise in multiple oncology indications including non-small cell lung cancer and multiple myeloma. Prior to joining DRG, Dr. Snigdha Gupta was a subject matter expert in immune-oncology, autoimmunity and dealt in generating in-depth framework based scientific analyses for client projects. In her previous organizations, she was involved in the planning and execution of the IND enabling preclinical studies. She has been instrumental in the stage-up of two small molecules at Bioxcel Therapeutics and Daiichi Sankyo Pharma India Pvt. Ltd. Dr. Gupta holds in infectious diseases from the Indian Institute of Chemical Biology, Jadavpur University, Kolkata while her post-doctoral fellowship is from the Mucosal immunology labs of National Institute of Immunology, New Delhi.
Laura Vinuesa, DVM, is a Senior Business Insights Analyst in the Oncology Division at Decision Resources Group, with expertise in thyroid carcinoma and bladder cancer. Previously, Dr. Vinuesa was an EU Market Access Analyst in the Global Market Access Insights Team at Decision Resources Group. She has expertise in market access, pricing and reimbursement, health technology assessment, and health policy. Prior to joining Decision Resources, she worked as Market Access & Institutional Relations Analyst at Pfizer in Spain, providing support for the successful market launch of drugs for different areas: cardiovascular, oncology, mental disorder and rare disease. She is a Doctor of Veterinary Medicine from the Complutense University of Madrid, and holds a in Clinical Research and Pharmaceutical Medicine from EPHOS - School of PharmaStudies. lvinuesa@
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.