In China, multiple myeloma treatment is centered on the use of three major agents—Janssen’s Velcade (bortezomib), Celgene’s Revlimid (lenalidomide), and thalidomide—while the treatment for non-Hodgkin’s lymphoma (NHL) has Roche’s MabThera (rituximab) and Chipscreen’s Epidaza (chidamide) as central players. However, these premium-priced agents face different degrees of coverage and restrictions on use. Multiple emerging agents are in development for multiple myeloma and NHL. Although many of these emerging therapies appear clinically promising, they will face considerable competition from current agents and China’s reimbursement environment. Drawing on insights from 50 surveyed oncologists and hematologists and 3 interviewed payers in China, this Access & Reimbursement module assesses the dynamics affecting uptake of high-cost therapies for NHL and multiple myeloma and examines the market access challenges, and strategies to circumvent them, that emerging therapies will encounter in the next two to three years.

Table of contents

  • Non-Hodgkin's Lymphoma And Chronic Lymphocytic Leukemia - Access & Reimbursement - Detailed, Expanded Analysis Non-Hodgkin's Lymphoma And Multiple Myeloma (China)
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for NHL and Multiple Myeloma Therapies in China
    • Successes and Stumbles
      • Successes Among NHL and Multiple Myeloma Therapies in China
      • Stumbles Among NHL and Multiple Myeloma Therapies in China
      • China: Reimbursement Successes & Stumbles
        • China: Reimbursement Successes and Stumbles Among Key Therapies for NHL and Multiple Myeloma
    • Key Stakeholders in the Road to Market Access
      • China
    • Key Market Access Roadblocks
      • Key Market Access Roadblocks for NHL and Multiple Myeloma Therapies in China
    • Reimbursement Dynamics
      • China: Reimbursement Dynamics for NHL and Multiple Myeloma Therapies
        • China: Drivers of Formulary Coverage for NHL and Multiple Myeloma Drugs
        • China: Reimbursement Details for Key Therapies for NHL and Multiple Myeloma
        • China: Key Background Details of the Healthcare System
        • China: P&R Process
        • China: P&R Process
        • China: Impact of Public Hospital Reform on Access to Patented Drugs for NHL and Multiple Myeloma
        • China: Impact of Public Hospital Reform on Access to Patent Drugs
        • China: Prescribing Controls and Monitoring
        • China: Patient Assistance Programs for NHL and Multiple Myeloma Therapies
    • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
      • Prescriber Preferences for NHL Treatment
        • Most Frequently Prescribed NHL Drugs by Line of Therapy
        • Patient Shares of MabThera Across the Major Subtypes of NHL
        • Preferred Treatment for NHL Under a Scenario of 100% Reimbursement
      • Prescriber Preferences for Multiple Myeloma Treatment
        • Patient Shares of Multiple Myeloma Therapies in the First Line of Therapy
        • Physicians’ Preferred Regimens for the Treatment of Multiple Myeloma in a Scenario of 100% Funding/Reimbursement
      • Impact of Payer Policy on Prescribing for NHL and Multiple Myeloma
        • Eligible Patients Not Receiving Therapy Due to Cost/Budgetary, Reimbursement, and/or Access Reasons
        • Physician-Reported Reimbursement and Access Factors in the Choice of NHL and Multiple Myeloma Treatment
      • Top Prescribing Drivers for NHL
        • Top Prescribing Drivers for NHL Therapies
      • Top Prescribing Drivers for Multiple Myeloma
        • Top Prescribing Drivers for Multiple Myeloma Drug Therapies
      • Key Levers and Constraints on Current Therapies
        • Key Levers and Constraints on Current NHL and Multiple Myeloma Therapies
    • Market Access Landscape for Emerging Therapies
      • Likely Impact of Emerging Therapies on NHL Treatment
        • Most Likely Use of Emerging Therapies Across NHL Subpopulations
      • Likely Impact of Emerging Therapies on Multiple Myeloma Treatment
        • Comparison of Kyprolis and Ixazomib for Multiple Myeloma
        • Panobinostat's Positioning in the Multiple Myeloma Treatment Algorithm
      • Market Access Challenges for Emerging Therapies for NHL and Multiple Myeloma
        • Top Factors Limiting Prescribing of Emerging Therapies for NHL by 2020
        • Preference for Anti-CD20 Therapy
        • Top Factors Limiting Prescribing of Emerging Therapies for Multiple Myeloma by 2020
      • Payer Opinion on Emerging Therapies for NHL and Multiple Myeloma
        • Payer Opinion on Biosimilars
        • Payer Opinion on Biosimilars' Impact on Brands
        • Payer Opinion on Biosimilars
        • Payer Opinion on Emerging Therapies for NHL
        • Payer Opinion on Emerging Therapies for NHL
        • Payer Opinion on Emerging Therapies for Multiple Myeloma
        • Payer Opinion on Emerging Therapies for Multiple Myeloma
    • Methodology
      • Abbreviations
      • Primary Research Design
      • Background of Payers and Payer-Advising KOLs
      • Physician Demographics and Practice Setting
        • Physician Specialty
        • Years Practiced Post-Residency
        • Number of NHL and Multiple Myeloma Patients Treated per Month
        • Practice Location
        • City of Practice
        • Hospital Type of Physician Practice
        • NHL Therapies Currently Prescribed by Surveyed Physicians Outside of Clinical Trials
        • Multiple Myeloma Therapies Currently Prescribed by Surveyed Physicians Outside of Clinical Trials
    • Appendix
      • Commercial Context
        • Diagnosed Incidence of NHL in China
        • Diagnosed Incident Cases of NHL and PTCL in China
        • Diagnosed Incidence of Multiple Myeloma in China
        • Diagnosed Incident Cases of Multiple Myeloma in China
        • Treatment Algorithm for Multiple Myeloma According to NCCN
        • Treatment Algorithm for NHL According to NCCN and CMA
        • Profiles of Key Targeted Therapies for NHL and Multiple Myeloma
        • Advantages and Disadvantages of Key Targeted Therapies for NHL and Multiple Myeloma
        • Price per Cycle of Select NHL and Multiple Myeloma Drugs
        • Timeline of Launch/Approvals of Key Current and Emerging Therapies for NHL and Multiple Myeloma
        • Emerging Therapy (NHL): Bendamustine
        • Bendamustine
        • Emerging Therapy (NHL): Imbruvica
        • Janssen's Imbruvica (ibrutinib)
        • Emerging Therapy (NHL): Arzerra
        • GlaxoSmithKline's Arzerra (ofatumumab)
        • Emerging Therapy (NHL): Gazyva
        • Roche's Gazyva (obinutuzumab)
        • Emerging Therapy (Multiple Myeloma): Farydak
        • Novartis's Farydak (panobinostat)
        • Emerging Therapy (Multiple Myeloma): Kyprolis
        • Amgen/Onyx's Kyprolis (carfilzomib)
        • Emerging Therapy (Multiple Myeloma): Ninlaro
        • Takeda/Millennium's Ninlaro (ixazomib)
      • Physician Survey Data
        • Commercial Insurance Coverage of NHL and Multiple Myeloma Patients
        • Benefits of Commercial Insurance
        • PRDL Coverage for MabThera in China
        • Reimbursement Rates of PRDL Coverage for MabThera in China
        • Patient Access Routes for NHL and Multiple Myeloma Drugs Not Covered by Government Insurance in China
        • Possibility of PRDL Inclusion of NHL and Multiple Myeloma Drugs in Next Update in China
        • Physicians' Preference Regarding NRDL Inclusion of NHL and Multiple Myeloma Drugs
        • Reasons for Non-Inclusion of NHL and Multiple Myeloma Drugs in NRDL
        • Catastrophic Diseases Coverage for NHL and Multiple Myeloma Drugs in China
        • Reimbursement Rates of Catastrophic Diseases Coverage for NHL and Multiple Myeloma Drugs in China
        • Impact of Catastrophic Diseases Coverage on Prescribing of NHL and Multiple Myeloma Drugs
        • Medicine Rate Targets in China
        • Impact of Medicine Rate Target on Prescribing of NHL and Multiple Myeloma Drugs
        • Impact of Zero Mark-Up Policy on Prescribing of NHL and Multiple Myeloma Drugs
        • Eligible Patients Not Receiving Therapy Due to Cost/Budgetary, Reimbursement, and/or Access Reasons
        • Reimbursement or Access Factors Limiting Prescribing of NHL and Multiple Myeloma Drugs
        • Factors Driving the Prescribing of Multiple Myeloma Therapies
        • Factors Driving the Prescribing of NHL Therapies
        • Patient Enrollment in Patient Assistance Programs for NHL and Multiple Myeloma Drugs
        • Factors Limiting Patient Assistance Program Participation
        • Newly Diagnosed NHL Patients, by Subtype
        • Newly Diagnosed T-Cell Lymphoma Patients, by Subtype
        • Current Drug Treatment Rates, by NHL Subtype
        • First-Line Drug Treatment Rates, by NHL Subtype, in 2020
        • MabThera's Patient Shares Across NHL Subtypes, by Line of Therapy
        • Impact of MabThera's Lack of Approval for MCL/CLL on Reimbursement and Prescribing
        • Patient Access Routes for Off-Label Use of Velcade and Revlimid for NHL
        • Off-Label Use of Velcade and Revlimid for NHL Patients
        • Patient Shares of Epidaza for NHL Patients
        • Most Frequently Prescribed NHL Drugs by Line of Therapy
        • Preferred Treatment for NHL Under a Scenario of 100% Reimbursement
        • Anticipated Future Prescribing of Bendamustine
        • Advantages of Imbruvica Over MabThera
        • Imbruvica's Positioning in the NHL Treatment Algorithm
        • Future Patient Shares of Imbruvica for CLL
        • Factors Influencing Physicians’ Prescribing of Arzerra or Gazyva over MabThera to NHL Patients
        • Arzerra and Gazyva's Positioning in the NHL Treatment Algorithm
        • Preference for Anti-CD20 Therapy
        • Future Patient Shares of Anti-CD20 Brands vs. Biosimilars
        • Unmet Needs for NHL Treatment
        • Prices of Emerging Therapies for NHL
        • Factors Limiting Prescribing of Emerging Therapies for NHL
        • Drug Treatment Rates for Multiple Myeloma Patients
        • Patient Shares of Multiple Myeloma Therapies in the First Line
        • Preferred Treatment for Multiple Myeloma Under a Scenario of 100% Reimbursement
        • Impact of Revlimid's Lack of Approval for First-Line Multiple Myeloma on Reimbursement and Prescribing
        • Impact of Revlimid's Approval for First-Line Multiple Myeloma in China on Prescribing
        • Most Frequently Prescribed Multiple Myeloma Therapies in the Second and Third Lines
        • Comparison of Kyprolis and Ixazomib for Multiple Myeloma
        • Future Patient Shares of Kyprolis and Ixazomib for Multiple Myeloma
        • Panobinostat's Positioning in the Multiple Myeloma Treatment Algorithm
        • Future Patient Shares of Panobinostat for Multiple Myeloma
        • Prices of Emerging Therapies for Multiple Myeloma
        • Factors Limiting Prescribing of Emerging Therapies for Multiple Myeloma
        • Unmet Needs for Multiple Myeloma Treatment

Author(s): Michelle Qian Zhou, MBBS, PhD; Andreia S. Ribeiro, PhD; Michelle Qian Zhou, MBBS, PhD

Michelle Zhou is a senior analyst at Decision Resources Group Hong Kong office. She is specialized in China research across multiple disease areas, working on multiple products, including Access & Reimbursement, and ChinaRx.

Prior to joining DRG, Dr. Zhou worked as a Scientist at New A Innovation Limited in Hong Kong where she managed preclinical studies in both mainland China and Hong Kong investigating new treatments for cancer and hemorrhagic shock. Dr. Zhou has a medical degree from Zhejiang University in China and a Ph.D. in clinical oncology from the Chinese University of Hong Kong, where she was involved in the investigation of novel therapeutics on signaling pathways in hepatocellular carcinoma.

Andreia Ribeiro, Ph.D., is a Director in DRG’s Market Access Insights team. In this role, she manages the Emerging and European Markets Access & Reimbursement portfolios, the industry’s only primary market research solution that includes insights from both physicians and payers to get a true sense of how both parties determine access to key pharmaceutical markets. She joined DRG over 4 years ago as a Latin American analyst where she has pioneered extensive primary and secondary research in the Brazil, Mexico, and Argentina payer systems exploring how the different reimbursement contexts impact prescribing.

Dr. Ribeiro has a Ph.D. in chemical and biochemical engineering from the University of Maryland Baltimore County focused on translational biomaterials research. She holds a B.S./M.S. degree from the University of Porto and two professional certifications in biochemical regulatory engineering and biotechnology management. A native of Portugal, Dr. Ribeiro is fluent in Portuguese and Spanish.

Michelle Zhou is a senior analyst at Decision Resources Group Hong Kong office. She is specialized in China research across multiple disease areas, working on multiple products, including Access & Reimbursement, and ChinaRx.

Prior to joining DRG, Dr. Zhou worked as a Scientist at New A Innovation Limited in Hong Kong where she managed preclinical studies in both mainland China and Hong Kong investigating new treatments for cancer and hemorrhagic shock. Dr. Zhou has a medical degree from Zhejiang University in China and a Ph.D. in clinical oncology from the Chinese University of Hong Kong, where she was involved in the investigation of novel therapeutics on signaling pathways in hepatocellular carcinoma.


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