Tens of thousands of Brazilian and Mexican men are diagnosed with prostate cancer every year. In recent years, there have been multiple clinical advances in the field, with new therapies offering longer survival times, milder safety and tolerability profiles and improved quality of life over existing treatments. However, those achievements have come with a hefty price tag and while the new therapies have become the standard of care in the United States and Europe, Brazil’s and Mexico’s cost-constrained markets are still struggling to widely adopt them in their medical practice. The future will bring more new prostate cancer therapies, and while prescribers are eager to use emerging agents, limited budgets will restrict their uptake and, in an increasingly competitive market, only drugs that meet both clinical and economic expectations will succeed. This A&R analysis provides key insights for navigating the prostate cancer market in Brazil and Mexico, uncovering payer and prescriber expectations in each country.

Table of contents

  • Prostate Cancer - Access & Reimbursement - Detailed, Expanded Analysis (Brazil/Mexico)
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for New Prostate Cancer Therapies in Brazil and Mexico
    • Successes and Stumbles
      • Successes Among Prostate Cancer Therapies in Brazil and Mexico
      • Stumbles Among Prostate Cancer Therapies 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
          • Brazil: Key Market Access Roadblocks
          • Mexico: Key Market Access Roadblocks
        • Reimbursement Dynamics
          • Brazil: Coverage Dynamics for Prostate Cancer
            • Brazil: HTA Process
            • Brazil: Drivers of Formulary Coverage for Prostate Cancer Drugs
            • Brazil: Coverage & HTA Details for Key Drugs for Metastatic Colorectal Cancer
            • Brazil: Coverage and HTA for Key Brands in Prostate Cancer
            • Brazil: Key Background Details of the Healthcare System
          • Mexico: Coverage Dynamics for Prostate Cancer
            • Mexico: HTA Details and Implications for Drug Coverage
            • Mexico: HTA Process
            • Mexico: Drivers of Formulary Coverage for Prostate Cancer Drugs
        • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
          • Prescriber Practices for Prostate Cancer
            • Prescriber Practices for Non-Metastatic Castration-Resistant Prostate Cancer
            • Most Frequently Prescribed Therapies for Non-Metastatic Castration-Resistant Prostate Cancer
            • Most Frequently Prescribed Therapies for First-Line Metastatic Castration-Resistant Prostate Cancer
            • Most Frequently Prescribed Therapies for Second-Line Metastatic Castration-Resistant Prostate Cancer
            • Most Frequently Prescribed Therapies for Third-Line Metastatic Castration-Resistant Prostate Cancer
          • Prescriber Preferences for Prostate Cancer
            • Percentage of Brazilian Patients Receiving Key Brands in First and Second Lines of mCRPC Treatment
            • Percentage of Mexican Patients Receiving Key Brands in First and Second Lines of mCRPC Treatment
            • Brazilian Oncologists' Choice of Prostate Cancer Therapies in Absence of Access Barriers
            • Mexican Oncologists' Choice of Prostate Cancer Therapies in Absence of Access Barriers
          • Impact of Payer Policy on Prescribing for Prostate Cancer
            • Percentage of Prostate Cancer Patients Eligible for Treatment vs. Those Receiving Treatment in Brazil
            • Percentage of Prostate Cancer Patients Eligible for Treatment vs. Those Receiving Treatment in Mexico
            • Percentage of Eligible Brazilian Patients Not Receiving Key Prostate Cancer Agents Due to Cost, Budgetary, or Reimbursement Restrictions
            • Percentage of Eligible Mexican Patients Not Receiving Key Prostate Cancer Agents Due to Cost, Budgetary, or Reimbursement Restrictions
            • Most Common Access Routes to Prostate Cancer Therapies with Insufficient Coverage in Brazil
            • Most Common Access Routes to Prostate Cancer Therapies with Insufficient Coverage in Mexico
          • Top Prescribing Drivers: Prostate Cancer
            • Best-Performing Therapies for Metastatic Castration-Resistant Prostate Cancer
            • Top Prescribing Drivers for First-Line Metastatic Castration-Resistant Prostate Cancer Patients
          • Key Levers and Constraints on Current Therapies
            • Levers and Constraints on Key Prostate Cancer Brands
        • Market Access Landscape for Emerging Therapies
          • Likely Impact of Emerging Therapies on Prostate Cancer
            • Potential Patient Shares for Emerging Prostate Cancer Therapies by 2019
            • Top Reasons for Potentially Prescribing Emerging Therapies to High-Risk Non-Metastatic Patients
            • Therapies Most Likely to Be Replaced with Emerging Therapies for High-Risk nmCRPC by 2019
            • Therapies Most Likely to Be Used in Combination with Emerging Therapies for High-Risk nmCRPC by 2019
          • Market Access Challenges for Emerging Therapies in Prostate Cancer
            • Best-Performing Emerging Therapies for nmCRPC
            • Physicians' Views on Reasonable Pricing for Emerging Therapies in Prostate Cancer
            • Top Reasons for Potentially Not Prescribing Emerging Therapies to High-Risk Non-Metastatic Patients
          • Payer Opinion on Emerging Therapies for Prostate Cancer
            • Brazil: Payer Opinion on Emerging Therapies in Prostate Cancer
            • Mexico: Payer Opinion on Emerging Therapies for Prostate Cancer
        • Methodology
          • Abbreviations
          • Background of Payers and Payer-Advising KOLs
          • Primary Research Design
          • Physician Demographics and Practice Setting
            • Country of Practice
            • Specialty
            • Years Practiced Postresidency
            • Practice Setting
            • Prostate Cancer Patients Treated per Month
            • Brazil: City of Practice
            • Mexico: City of Practice
            • Hospital Type
            • Mexico: Public Hospital Affiliation
            • Experience with Prescribing of Key Prostate Cancer Drugs Outside Clinical Trials
        • Appendix
          • Commercial Context
            • Epidemiology: Diagnosed Prevalent Cases by Geography
            • Guidelines for Prostate Cancer
            • Sources of Treatment Guidelines for Prostate Cancer
            • Profiles of Key Brands for Prostate Cancer in Brazil and Mexico
            • Advantages and Disadvantages of Key Brands for Prostate Cancer
            • Cost of Key Hormonal Agents for Prostate Cancer
            • Cost of Key Chemotherapy and Radiopharmaceutical Agents for Prostate Cancer
            • Brazil: APAC Values for Metastatic Prostate Cancer Treatments
            • Timeline of Approvals of Key Current Brands and Emerging Therapies
            • Emerging Therapy: Apalutamide
            • Johnson & Johnson's Apalutamide
            • Emerging Therapy: ODM-201
            • Orion/Bayer HealthCare's ODM-201
          • Physician Survey Data
            • Percentage of Prostate Cancer Patients Eligible for Treatment vs. Those Receiving Treatment in Brazil
            • Percentage of Prostate Cancer Patients Eligible for Treatment vs. Those Receiving Treatment in Mexico
            • Coverage of Key Prostate Cancer Agents in Brazil
            • Coverage of Key Prostate Cancer Agents in Mexico
            • Percentage of Eligible Brazilian Patients Not Receiving Key Prostate Cancer Agents Due to Cost, Budgetary, or Reimbursement Restrictions
            • Percentage of Eligible Mexican Patients Not Receiving Key Prostate Cancer Agents Due to Cost, Budgetary, or Reimbursement Restrictions
            • Coverage/Reimbursement and Cost Restrictions Limiting Prescribing of Key Prostate Cancer Agents in Brazil
            • Coverage/Reimbursement and Cost Restrictions Limiting Prescribing of Key Prostate Cancer Agents in Mexico
            • Most Common Access Routes to Prostate Cancer Therapies with Insufficient Coverage in Brazil
            • Most Common Access Routes to Prostate Cancer Therapies with Insufficient Coverage in Mexico
            • Prostate Cancer Therapies Reimbursed Under APAC in Brazil
            • Most Frequently Prescribed Therapies for Non-Metastatic Castration-Resistant Prostate Cancer
            • Most Frequently Prescribed Therapies for First-Line Metastatic Castration-Resistant Prostate Cancer
            • Most Frequently Prescribed Therapies for Second-Line Metastatic Castration-Resistant Prostate Cancer
            • Most Frequently Prescribed Therapies for Third-Line Metastatic Castration-Resistant Prostate Cancer
            • Percentage of Brazilian Patients Receiving Key Brands in First and Second Lines of mCRPC Treatment
            • Percentage of Mexican Patients Receiving Key Brands in First and Second Lines of mCRPC Treatment
            • LHRH Agonists in Brazil: Reasons for Prescribing to First-Line mCRPC Patients
            • LHRH Agonists in Mexico: Reasons for Prescribing to First-Line mCRPC Patients
            • Antiandrogens in Brazil: Reasons for Prescribing to First-Line mCRPC Patients
            • Antiandrogens in Mexico: Reasons for Prescribing to First-Line mCRPC Patients
            • Zytiga in Brazil: Reasons for Prescribing to First-Line mCRPC Patients
            • Zytiga in Mexico: Reasons for Prescribing to First-Line mCRPC Patients
            • Combined Androgen Blockade in Brazil: Reasons for Prescribing to First-Line mCRPC Patients
            • Combined Androgen Blockade in Mexico: Reasons for Prescribing to First-Line mCRPC Patients
            • Xtandi in Brazil: Reasons for Prescribing to Private First-Line mCRPC Patients
            • Xtandi in Mexico: Reasons for Prescribing to Private First-Line mCRPC Patients
            • Docetaxel in Brazil: Reasons for Prescribing to First-Line Metastatic Castration-Resistant Prostate Cancer Patients
            • Docetaxel in Mexico: Reasons for Prescribing to First-Line Metastatic Castration-Resistant Prostate Cancer Patients
            • Jevtana in Brazil: Reasons for Prescribing to Metastatic Castration-Resistant Prostate Cancer Patients
            • Best-Performing Therapies for Metastatic Castration-Resistant Prostate Cancer
            • Brazilian Oncologists' Choice of Prostate Cancer Therapies in Absence of Access Barriers
            • Mexican Oncologists' Choice of Prostate Cancer Therapies in Absence of Access Barriers
            • Potential Label Expansions for Zytiga and Xtandi
            • Sequencing of Treatments for Asymptomatic or Minimally Symptomatic First-Line mCRPC Patients in Private Sector
            • Sequencing of Treatments for Symptomatic First-Line mCRPC Patients in Private Sector
            • Sequencing of Treatments for Asymptomatic or Minimally Symptomatic First-Line mCRPC Patients in Public Sector
            • Sequencing of Treatments for Symptomatic First-Line mCRPC Patients in Public Sector
            • Potential Patient Shares for Emerging Prostate Cancer Therapies
            • Reasons for Potentially Prescribing Emerging Therapies to High-Risk nmCRPC Patients in Brazil
            • Reasons for Potentially Prescribing Emerging Therapies to High-Risk nmCRPC Patients in Mexico
            • Reasons for Potentially Not Prescribing Emerging Therapies to High-Risk nmCRPC Patients in Brazil
            • Reasons for Potentially Not Prescribing Emerging Therapies to High-Risk nmCRPC Patients in Mexico
            • Therapies Most Likely to Be Replaced with Emerging Therapies for High-Risk nmCRPC
            • Therapies Most Likely to Be Used in Combination with Emerging Therapies for High-Risk nmCRPC
            • Best-Performing Emerging Therapies for Non-Metastatic Castration-Resistant Prostate Cancer
            • Physicians' Views on Reasonable Pricing for Emerging Therapies in Prostate Cancer

      Author(s): Natalia Reoutova, MSc, MA

      Natalia Reoutova, M.A., M.Sc., is a senior business insights analyst in the oncology division at Decision Resources Group. Ms. Reoutova has worked on a range of oncology indications including prostate cancer and malignant melanoma. She has authored reports on non-small-cell lung cancer and colorectal cancer, and worked on publications covering both the major and emerging pharmaceutical markets.

      Natalia Reoutova holds a M.A. in natural sciences (specializing in pharmacology) from the University of Cambridge and a M.Sc. in drug discovery from the University of London. Her postgraduate research focused on developing small-molecule inhibitors of oncogenic transcription factors. Prior to working at Decision Resources, she was responsible for planning and estimating the cost of clinical trials at Pharm-Olam International.


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