Faced with the financial pressures of reimbursing a robust pipeline of new and expensive cancer therapies, U.S. managed care organizations (MCOs) are increasing their focus on managing the utilization of therapies through controls such as prior authorization, step therapy, and limits on prescription supplies. Increasingly, utilization management is being applied not only to drugs obtained from pharmacies but also to those administered by medical professionals and covered under their insured patients’ medical benefit. The entry of several novel agents targeting non-small-cell lung cancer (NSCLC), particularly the new immune checkpoint inhibitors, makes the NSCLC market ripe for examination of utilization management strategies. Presenting data from surveys of 39 MCOs and 100 oncologists, this access and reimbursement content analyzes the reimbursement environment for eight of the most promising 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.


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