Colorectal Cancer | Access & Reimbursement | Detailed, Expanded Analysis (Brazil/Mexico)

Publish date: September 2016

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Introduction

Colorectal cancer (CRC) affects several thousands of people in Brazil and Mexico. Once it metastasizes, the only available therapeutic options are premium-priced targeted agents and chemotherapy. In Mexico, coverage varies across the different healthcare programs, and in Brazil, the uniqueness of public funding for oncology drugs limits public coverage of treatments. The future will bring an influx of new drugs and biosimilars, and while both countries are eager to adopt new technologies, they have limited budgets. In this increasingly competitive market, only drugs that meet the clinical and economic expectations of both countries will achieve success.This A&R analysis provides key insights for navigating the CRC therapy market in Brazil and Mexico and adapting a branded therapy’s value message to payers and physician needs and expectations in each country.​ 

Scope:

Decision Resources Group’s Access and Reimbursement module for colorectal cancer in Brazil and Mexico explores the prescribing patterns for current CRC therapies; the potential impact of the anticipated arrival of novel therapies; and key national, regional, and institutional market access factors that will shape the use of CRC therapies over the next two to three years. This report draws on insights from 104 surveyed physicians and from interviews with 6 payers in Brazil and Mexico, all of whom have influence at the institutional, regional, or national level.

Markets covered: Brazil and Mexico.

Primary research:

  • 104 oncologists/medical oncologists
  • 6 payers:
    • Brazil:
      • Senior Member of the Department of Logistics, Purchasing, and Dispensing of Drugs in a reference institution for cancer treatment.
      • Pharmacology Commission member in national reference institution in São Paulo.
      • Head of medical audit department of a major HMO.
    • Mexico
      • National coordinator of Special Programs at ISSSTE.
      • Head of the Department of Oncology at an IMSS hospital.
      • Head of the Department of Medical Oncology at INCAN.



Questions Answered in This Report:

  • What is the public and private healthcare coverage for premium-priced CRC therapies in Brazil and Mexico? How do payers’ policies and infrastructure influence access to specialized healthcare and treatments?
  • What are the current drivers of and barriers to the prescribing of premium-priced CRC therapies? What are the main cost-related/clinical constraints to uptake?
  • What is surveyed physicians’ and payers’ expected pricing of emerging therapies for CRC?
  • How do payers expect access to premium-priced therapies and biosimilars for CRC to evolve in the next three years, and which emerging therapies do payers expect will be covered?
  • How do physicians expect to prescribe emerging agents and biosimilars for CRC? What are these therapies’ likely impact on current brands over the next three years?
  • What clinical benefits do physicians and payers in Brazil and Mexico seek from emerging CRC therapies? What types of savings on direct and indirect costs are payers looking for?
  • What roles will head-to-head and pharmacoeconomic outcomes play in differentiating the reimbursement of high-priced targeted therapies versus currently available targeted therapies?

Table of contents

  • Detailed, Expanded Analysis (Brazil/Mexico)
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for New Metastatic Colorectal Cancer Therapies in Brazil and Mexico
    • Successes and Stumbles
      • Successes Among Targeted Therapies for Metastatic CRC in Brazil and Mexico
      • Stumbles Among Targeted Therapies for Metastatic CRC in Brazil and Mexico
      • Brazil: Coverage Successes & Stumbles
      • Mexico: Coverage Successes & Stumbles
    • Key Stakeholders in the Road to Market Access
      • Brazil
      • Mexico
    • Key Market Access Roadblocks
      • Key Market Access Roadblocks for Metastatic CRC Therapies in Brazil and Mexico
      • Brazil: Key Market Access Roadblocks
      • Mexico: Key Market Access Roadblocks
    • Reimbursement Dynamics
      • Brazil: Coverage Dynamics for Metastatic Colorectal Cancer
        • Brazil: HTA Details and Implications in Drug Coverage
        • Brazil: Drivers of Formulary Coverage
        • Brazil: Coverage & HTA Details
        • Brazil: Lessons Learned and Key Takeaways
        • Brazil: Reimbursement Background
      • Mexico: Coverage Dynamics for Metastatic Colorectal Cancer
        • Mexico: HTA Details and Implications in Drug Coverage
        • Mexico: Drivers of Formulary Coverage
        • Mexico: Coverage Details
        • Mexico: Lessons Learned and Key Takeaways
        • Mexico: Reimbursement Background
    • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
      • Prescriber Preferences for Therapies for Wild-Type RAS Patients
      • Prescriber Preferences for Therapies for Mutated RAS Patients
      • Prescriber Preferences for Biosimilars
      • Impact of Payer Policy on Prescribing for Metastatic Colorectal Cancer
      • Top Prescribing Drivers: Metastatic Colorectal Cancer
      • Key Levers and Constraints on Current Therapies
    • Market Access Landscape for Emerging Therapies
      • Likely Impact of Emerging Therapies on the Treatment of Metastatic Colorectal Cancer
      • Market Access Challenges for Emerging Therapies for Metastatic Colorectal Cancer
      • Payers' Opinion of Emerging Therapies for Metastatic Colorectal Cancer
    • Methodology
      • Primary Research Design
      • Physician Demographics and Practice Setting
      • Pricing Methodology
    • Appendix
      • Commercial Context
        • Epidemiology: Diagnosed Prevalence of Colorectal Cancer in Brazil and Mexico
        • Treatment Guidelines for Colorectal Cancer in Brazil and Mexico
        • Key Drugs for Metastatic Colorectal Cancer
        • Price per Four Weeks of Treatment with Metastatic Colorectal Cancer Drugs
        • Timeline of Approvals of Key Drugs for Metastatic Colorectal Cancer
        • Profiles of Emerging Therapies
        • Brazil: Productive Development Partnerships
        • Brazil: Public and Private Reference Hospitals for Colorectal Cancer
        • Mexico: Public and Private Reference Hospitals for Colorectal Cancer
      • Physician Survey Data

Author(s): Nuno Tiago Giao Antunes, PhD

Nuno T. Antunes, ,  is senior business insights analyst on the Infectious, Niche, and Rare Diseases team at Decision Resources Group, specializing in antibacterial agents. Previously, he was a Latin America Market Access senior analyst in the Global Market Access Insights Team, where he developed expertise in market access, pricing and reimbursement, health technology assessment, and health policy. Nuno holds a in animal health from the Universidad de las Palmas de Gran Canaria, Spain, and a degree from the Universidade de Trás-os-Montes e Alto Douro, Portugal. Prior to joining DRG, he conducted research in antimicrobial resistance and antimicrobial development, and worked in the medical devices industry as a scientist.