Breast cancer affects thousands of individuals in Brazil and Mexico, and is managed with premium-priced agents, chemotherapy, and hormone therapy. In Mexico, coverage of treatment varies across the different healthcare programs; in Brazil, Herceptin is covered, but the uniqueness of public funding for oncology drugs makes public coverage of other treatments limited. 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 an 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 HER2-positive breast cancer market in Brazil and Mexico, while adapting brand agents’ value message to payers’ and physicians’ needs and expectations in each country.

Scope:

Decision Resources Group’s Access and Reimbursement module for Breast Cancer in Brazil and Mexico explores the prescribing patterns for current HER2-targeted therapies, the potential impact of the anticipated arrival of novel therapies, and key national and regional market access factors that will shape the use of HER2-targeted therapies over the next two to three years. This content draws on insights from 100 surveyed physicians and from interviews with six payers in Brazil and Mexico, all of whom have influence at the regional or national level.

Markets covered: Brazil and Mexico

Primary research:

  • 100 oncologists/medical oncologists
  • 6 payers:
    • Brazil:
      • Pharmacist, specializing in public health. Member of the Department of Health of the State of São Paulo. Senior member of CCTIES (Coordinator of Science, Technology and Strategic Health Supplies) of the State of São Paulo. Close collaborator to MoH and CONITEC.
      • Clinical oncologist in reference hospitals in the public and private settings. Member of the Standardization Committee of New Technologies and responsible for elaboration of new protocols in public reference hospital. Member of the American Society of Clinical Oncology (ASCO).
      • Physician, Director of major HMO of the self-management type. Member of the Advisory Committee of the International Society for Pharmacoeconomics and Outcomes Research - ISPOR Latin America.
    • Mexico:
      • Head of the Department of Programming of Assets of Medical Supplies at ISSSTE.
      • Head of the Service of Medical Oncology at Medical Center of IMSS. Opinion leader in Mexico and Latin America. Member of the Society of Medical Oncology of IMSS. Member of National Coordination for the Creation of Diagnostic Guides - Therapeutics in the Oncology area of the IMSS. Active member of the Mexican Council of Oncology.
      • Oncologist, Chief of the Oncology and Radiotherapy Service of Hospital of the Secretary of Health. Member of the Mexican Council of Oncology.

Questions Answered in This Report:

  • What is the public and private healthcare coverage for premium-priced therapies for HER2-positive breast cancer, and how do payers’ policies and infrastructure influence access to specialized healthcare and treatments?
  • What are the current drivers and barriers for prescribing established premium-priced agents such as Herceptin, or newer agents such as Perjeta?
  • What will be the impact of biosimilars of trastuzumab in the prescription of Herceptin and other premium-priced agents?
  • What clinical benefits are physicians and payers looking for in emerging therapies such as margetuximab or neratinib, and what kind of savings in direct and indirect costs are payers looking for?

Table of contents

  • Breast Cancer - Access & Reimbursement - Detailed, Expanded Analysis (Brazil And Mexico)
    • Key Updates
      • November 2017
      • August 2017
    • Market Access Overview
      • Actionable Recommendations to Optimize Market Access
        • Optimizing Market Access Opportunity for New Breast Cancer Therapies in Brazil and Mexico
      • Successes and Stumbles for HER2-Targeted Therapies in Breast Cancer
        • Successes Among HER2-Targeted Breast Cancer Therapies in Brazil and Mexico
        • Stumbles Among HER2-Targeted Breast 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
            • Key Market Access Roadblocks for HER2-Targeted Breast Cancer Therapies in Brazil and Mexico
            • Brazil: Key Market Access Roadblocks
            • Mexico: Key Market Access Roadblocks
          • Reimbursement Dynamics
            • Brazil: Coverage Dynamics for Breast Cancer
              • Brazil: HTA Process
              • Brazil: Drivers of Formulary Coverage for Breast Cancer Drugs
              • Brazil: Coverage and HTA Details for Key Drugs in HER2-Positive Breast Cancer
              • 2017 SUS Update for First-Line Use of Herceptin
              • Brazil: Key Background Details of the Healthcare System
            • Mexico: Reimbursement/Coverage Dynamics for Breast Cancer
              • Mexico: HTA Process
              • Mexico: Drivers of Formulary Coverage for Breast Cancer Drugs
              • Mexico: Coverage Details for Key Drugs in HER2-Positive Breast Cancer
              • Mexico: Key Background Details of the Healthcare System
          • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
            • Prescriber Preferences for Advanced/Metastatic 1st Line Therapy of HER2-Positive Breast Cancer
              • Patient Shares for Advanced/Metastatic First-Line Therapy of HER2-Positive Breast Cancer
            • Prescriber Preferences for Advanced/Metastatic 2nd and 3rd Lines of Therapy of HER2-Positive Breast Cancer
              • Brazil: Patient Shares for Advanced/Metastatic Second and Third Lines Therapy of HER2-Positive Breast Cancer
              • Mexico: Patient Shares for Advanced/Metastatic Second and Third Lines Therapy of HER2-Positive Breast Cancer
            • Prescriber Preferences for Biosimilars
              • Prescribing of Biosimilars Within Two Years' Availability
            • Impact of Payer Policy on Prescribing for HER2-positive Breast Cancer
              • Percentage of Breast Cancer Patients Receiving Treatment
              • Percentage of Treatment-Eligible Patients Not Receiving Targeted Therapies Because of Cost, Budgetary, or Reimbursement Reasons
              • Top Coverage/Reimbursement and Cost Restrictions Limiting Prescribing for HER2-Positive, Treatment-Eligible Breast Cancer Patients
              • Most Common Access Routes to Targeted Therapies When Unavailable or Uncovered
              • Impact of Payer Policy on Prescribing for HER2-Positive Breast Cancer: Changes in Prescribing Without Access Barriers
              • Oncologists' Choice of Treatments for Advanced/Metastatic HER2-Positive Breast Cancer in the Absence of Access Barriers
            • Top Prescribing Drivers for First Line Advanced/Metastatic HER2-Positive Breast Cancer
              • Brazil: Top Prescribing Drivers for First-Line Advanced/Metastatic HER2-Positive Breast Cancer
              • Mexico: Top Prescribing Drivers for First-Line Advanced/Metastatic HER2-Positive Breast Cancer
            • Key Levers and Constraints on Current Therapies
            • Market Access Landscape for Emerging Therapies
              • Likely Impact of Emerging Therapies on HER2-Positive Breast Cancer
                • Oncologists' Willingness to Prescribe Emerging Therapies Once Approved
                • Drivers and Preferences to Prescribe Emerging Therapies
              • Market Access Challenges for Emerging Therapies in Recurrent HER2-Positive Breast Cancer
                • Brazil: Expected Choices of Second- and Third-Line Treatments for Breast Cancer Patients
                • Mexico: Expected Choices of Second- and Third-Line Treatments for Breast Cancer Patients
              • Payer Opinion on Emerging Therapies for Breast Cancer
                • Brazil: Payer Opinion on Emerging Therapies for HER2-Positive Breast Cancer
                • Mexico: Payer Opinion on Emerging Therapies for HER2-Positive Breast Cancer
            • Methodology
              • Abbreviations
              • Primary Research Design
              • Background of Payers and Payer-Advising KOLs
              • Physician Demographics and Practice Setting
                • In What Country Is Your Practice Located?
                • How Many Years Have You Practiced Postresidency?
                • How Would You Best Describe the Setting(s) in Which You Practice?
                • How Many Adult Patients (Aged 18 or Older) with the Following Indications Do You See (Treat or Monitor) per Month?
                • Brazil: In What City Is Your Practice Located?
                • Mexico: In What City Is Your Practice Located?
                • What Type of Hospital(s) Do You Practice at?
                • Mexico: What Is Your Public Hospital Affiliation?
                • Which of the Following Therapies Do You Have Experience Prescribing to Your HER2-Positive Adult Breast Cancer Patients Outside of Clinical Trials?
              • Pricing Methodology
            • Appendix
              • Commercial Context
                • Epidemiology: Diagnosed Prevalence of HER2-Positive Breast Cancer in Brazil and Mexico
                • Brazil: Treatment Guidelines for HER2-Positive Breast Cancer in Brazil
                • Treatment Guidelines for HER2-Positive Breast Cancer in Mexico
                • Sources of Treatment Guidelines for Breast Cancer
                • Profiles of Key Drugs for HER2-Positive Breast Cancer in Brazil and Mexico
                • Advantages and Disadvantages of Drugs for HER2-Positive Breast Cancer
                • Brazil: APAC Values for HER2-Positive Breast Cancer Treatments
                • Brazil: APAC Values for HER2-Positive Breast Cancer Treatments
                • Timeline of Approvals of Key Current and Emerging Therapies for HER2-Positive Breast Cancer
                • Key Finding for Neratinib
                • Puma Biotechnology's Neratinib
                • Key Finding for Margetuximab
                • MacroGenics' Margetuximab
                • Brazil: Productive Development Partnerships for Trastuzumab
                • Brazil: Phases of the Productive Development Partnerships
              • Physician Survey Data
                • Percentage of Breast Cancer Patients Receiving Treatment
                • Brazil: Formulary Inclusion of Key Therapies for HER2-Positive Breast Cancer
                • Mexico: Formulary Inclusion of Key Therapies for HER2-Positive Breast Cancer
                • Percentage of Patients Not Receiving Key Treatments for HER2-Positive Breast Cancer Due to Budgetary/Reimbursement Reasons
                • Brazil: Coverage/Reimbursement and Cost Restrictions Limiting Prescribing for Treatment-Eligible HER2-Positive Breast Cancer Patients
                • Mexico: Coverage/Reimbursement and Cost Restrictions Limiting Prescribing for Treatment-Eligible HER2-Positive Breast Cancer Patients
                • Common Access Routes to Key HER2-Targeted Therapies When Unavailable or Uncovered
                • Brazil: Reimbursement of Key HER2-Targeted Drugs Under the APAC
                • Biomarker Testing
                • Average Turnaround Time for Biomarker Testing
                • Patient Shares in the Public Setting
                • Patient Shares in the Private Setting
                • Prescribing Drivers for Key HER2-Targeted Drugs as First-Line Treatment of Choice
                • Prescribing Drivers for Chemotherapy as First-Line Treatment of Choice
                • Prescribing Drivers for Herceptin + Perjeta + Chemotherapy as First-Line Treatment of Choice
                • Prescribing Drivers for Herceptin +/- Chemotherapy as First Line Treatment of Choice
                • Brazil: Anticipated Impact of Coverage of Herceptin + Perjeta + Chemotherapy for First Line of Therapy
                • Percentage of Patients Receiving IV and SC Herceptin
                • Oncologists' Choice of Treatments in the Absence of Access Barriers
                • Expected Patient Shares for Biosimilars in Breast Cancer Patients Two Years After Launch
                • Oncologists’ Reasons for Not Prescribing Biosimilars Within Two Years of Launch
                • Brazil: Impact of Availability of Trastuzumab Biosimilar on Public Patient Access
                • Oncologists' Willingness to Prescribe Emerging Therapies
                • Drivers and Preferences to Prescribe Emerging Therapies
                • Expected Choices of Treatments for HER2-Positive Breast Cancer Patients
                • Brazil: Expected Choices of Treatments for HER2-Positive Breast Cancer Patients
                • Mexico: Expected Choices of Treatments for HER2-Positive Breast Cancer Patients

          Author(s): Nuno Tiago Giao Antunes, PhD

          Nuno T. Antunes, Ph.D., 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 Ph.D. in animal health from the Universidad de las Palmas de Gran Canaria, Spain, and a D.V.M. 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.


          Related Reports

          Breast Cancer - Landscape & Forecast - Disease Landscape & Forecast

          The breast cancer therapy market is rapidly evolving and presents new commercial opportunities for drug developers. CDK4/6 inhibitors (Pfizer’s...

          View Details

          Breast Cancer | Disease Landscape and Forecast | G7 | 2020

          The breast cancer market is rapidly evolving and presents new commercial opportunities for drug developers. CDK4/6 inhibitors (Pfizer’s Ibrance, Novartis’s Kisqali, and Eli Lilly’s Verzenio / Verze...

          View Details

          Breast Cancer - Geographic Focus: China - Breast Cancer - China In-Depth (China)

          Breast cancer is the most commonly diagnosed cancer among Chinese women. A high incidence and a prolonged treatment duration make the treatment of breast cancer a lucrative commercial opportunity f...

          View Details

          Non-Hodgkin's Lymphoma And Chronic Lymphocytic Leukemia - Epidemiology - Janssen Proprietary Content

          In this project, comissioned by Janssen in December, 2018, we have packaged our published estimates on the epidemiology of CLL - drug treated population across all the countries in Latin Ameri...

          View Details