Seven premium-priced therapies—Avastin (Roche), Erbitux (Merck KGaA), Vectibix (Amgen), Zaltrap (Regeneron/Sanofi), Cyramza (Eli Lilly), Stivarga (Bayer HealthCare), and Lonsurf (Servier)—are approved in Europe for metastatic colorectal cancer. Cyramza and Lonsurf are recent additions to the treatment armamentarium, and further options look set to penetrate the market in the next few years. Ever-increasing and ever-more-costly treatment options, as well as the evolution of biomarker-driven prescribing for colorectal cancer, and the costs that go with it, mean oncologists are striving to optimize the treatment algorithm and maximize treatment outcome for patients, while payers are balancing clinical need with economic constraints. This research analyzes the evolving prescribing landscape for metastatic colorectal cancer, and the impact of payer policy upon it.

Questions Answered

  • What are the current drivers of and barriers to prescribing of key brands for mCRC, and what are the main cost-related and clinical constraints on uptake?
  • How do European product labeling and national, regional, and local reimbursement restrictions differentially impact use of key brands in mCRC?
  • How might evolving healthcare reforms and cost-containment strategies affect reimbursement of novel agents? How challenging will country– and region-specific prescribing constraints be for uptake of these therapies?
  • To what extent will oncologists and payers embrace the costly emerging agents Keytruda (Merck & Co.), triplet combination binimetinib, encorafenib, and Erbitux (Array BioPharma/Pierre Fabre/Merck KGaA), and Tecentriq plus Cotellic (Roche)?

Product Description

Access & Reimbursement: Provides in-depth insight into the impact of payer policy on physician prescribing behavior so you can build your market access strategy and optimize your brand positioning.

Table of contents

  • Colorectal Cancer - Access & Reimbursement - Detailed, Expanded Analysis (EU5)
    • Key Updates
      • December 2017
    • Market Access Overview
      • Actionable Recommendations to Optimize Market Access
        • Optimizing Market Access Opportunity for Colorectal Cancer Therapies in the EU5
      • Successes and Stumbles
        • Successes and Stumbles Among Metastatic Colorectal Cancer Therapies in the EU5
        • Overview of Successes and Stumbles Among Metastatic Colorectal Cancer Therapies in the EU5
      • Key Stakeholders in the Road to Market Access
        • France
        • Germany
        • Italy
        • Spain
        • United Kingdom
      • Key Market Access Roadblocks
        • Reimbursement Dynamics
          • France
            • France: Crucial HTA Criteria
            • France: P&R Drivers and Key HTA Considerations
            • France: HTA Review Details
            • France: Reimbursement Regulations and Prescribing Parameters
            • France: Key Takeaways
          • Germany
            • Germany: Crucial HTA Criteria
            • Germany: P&R Drivers and Key HTA Considerations
            • Germany: HTA Review Details
            • Germany: Reimbursement Regulations and Prescribing Parameters
            • Germany: Key Takeaways
          • Italy
            • Italy: Crucial HTA Criteria
            • Italy: P&R Drivers and Key HTA Considerations
            • Italy: HTA Review Details
            • Italy: Reimbursement Regulations and Prescribing Parameters
            • Italy: Key Takeaways
          • Spain
            • Spain: Crucial HTA Criteria
            • Spain: P&R Drivers and Key HTA Considerations
            • Spain: P&R Drivers and Key HTA Considerations
            • Spain: HTA Review Details
            • Spain: Reimbursement Regulations and Prescribing Parameters
            • Spain: Key Takeaways
          • United Kingdom
            • United Kingdom: Crucial HTA Criteria
            • United Kingdom: P&R Drivers and Key HTA Considerations
            • United Kingdom: HTA Review Details
            • United Kingdom: Reimbursement Regulations and Prescribing Parameters
            • United Kingdom: Key Takeaways
        • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
          • Prescriber Preferences for Metastatic Colorectal Cancer
            • Prescriber Preferences for First-Line Metastatic Colorectal Cancer
            • Patient Shares for First-Line Treatment of Metastatic Colorectal Cancer
            • Prescriber Preferences in the Absence of Reimbursement/Access Issues for First-Line Metastatic Colorectal Cancer
            • Prescriber Preferences for Second-Line Metastatic Colorectal Cancer
            • Patient Shares for Second-Line Treatment of Metastatic Colorectal Cancer
            • Prescriber Preferences in the Absence of Reimbursement/Access Issues for Second-Line Metastatic Colorectal Cancer
            • Prescriber Preferences for Third- and Later-line Metastatic Colorectal Cancer
            • Patient Shares for Third- and Later-Line Metastatic Colorectal Cancer
          • Impact of Payer Policy on Prescribing for Metastatic Colorectal Cancer
            • Overall Impact of EU5 Payer Policy on Prescribing for Metastatic Colorectal Cancer
            • Clinical and Nonclinical Factors Restricting Prescribing of Key Agents for Metastatic Colorectal Cancer
            • Impact of Country-Specific Payer Policy on Prescribing for Metastatic Colorectal Cancer
            • Impact of ALD Status on Prescribing of Metastatic Colorectal Cancer Therapies: France
            • Impact of Richtgrößen on Patient Access to Metastatic Colorectal Cancer Therapies: Germany
            • Impact of AIFA's Monitoring Registry on Prescribing of Metastatic Colorectal Cancer Therapies: Italy
            • Impact of IPT Terms on Prescribing of Metastatic Colorectal Cancer Therapies: Spain
            • Impact of Prescribing Guidelines in Local Authority/CCG and Hospitals/Clinics in the United Kingdom
          • Top Prescribing Drivers in Metastatic Colorectal Cancer
            • Top Prescribing Drivers of Therapies for Metastatic Colorectal Cancer
            • Top Prescribing Driver for First-, Second, and Third- and Later-Line Treatment for Mutant RAS Metastatic Colorectal Cancer
            • Top Prescribing Drivers of First-, Second, and Third- and Later-Line Treatment for Wild-Type RAS Metastatic Colorectal Cancer
        • Market Access Landscape for Emerging Therapies
          • Likely Impact of Emerging Therapies for Metastatic Colorectal Cancer
            • Expected Uptake of Emerging Therapies for Metastatic Colorectal Cancer
            • Expected Patient Share for Keytruda in MSI-High or MMR-Deficient First- and Second-Line Metastatic Colorectal Cancer
            • Expected Patient Share for Binimetinib + Encorafenib + Erbitux in Second- and Later-Line BRAF-Mutant Metastatic Colorectal Cancer
            • Expected Patient Share for Tecentriq + Cotellic in Third- and Later-Line Metastatic Colorectal Cancer
            • Likely Impact of Emerging Metastatic Colorectal Cancer Therapies on Currently Used Treatments
            • Impact of Keytruda on the Future Prescribing of Currently Available Agents in First-Line Metastatic Colorectal Cancer
            • Impact of Keytruda on the Future Prescribing of Currently Available Agents in Second-Line Metastatic Colorectal Cancer
            • Impact of Tecentriq Plus Cotellic on the Future Prescribing of Currently Available Agents in Third- and Later-Line Metastatic Colorectal Cancer
            • Impact of Binimetinib Plus Encorafenib and Erbitux on the Future Prescribing of Currently Available Agents in Second- and Third-/Later-Line Metastatic Colorectal Cancer
          • Market Access Challenges for Emerging Metastatic Colorectal Cancer
            • Factors Expected to Limit Prescribing of Emerging Metastatic Colorectal Cancer Therapies
            • Factors Expected to Limit Prescribing of Keytruda for Metastatic Colorectal Cancer
            • Factors Expected to Limit Prescribing of Tecentriq Plus Cotellic for Metastatic Colorectal Cancer
            • Factors Expected to Limit Prescribing of Binimetinib Plus Encorafenib and Erbitux for Metastatic Colorectal Cancer
            • Physician Perspective on Use of and Challenges for Keytruda and Tecentriq
            • Physician Perspective on Keytruda for Colorectal Cancer
            • Physician Perspective on Tecentriq Plus Cotellic for Colorectal Cancer
          • Payer Opinion on Emerging Therapies for Metastatic Colorectal Cancer
            • Payer Opinion on Emerging Colorectal Cancer Therapies
        • Methodology
          • Abbreviations
          • Primary Research Design
          • Background of Payers and Payer-Advising KOLs
          • Physician Demographics and Practice Setting
            • Physician Speciality
            • Year in Practice Post-Residency
            • Average Number of Patients Treated per Month with Metastatic Colorectal Cancer
            • Country Practice Location
            • UK Practice Location
            • Agents Prescribed Outside of a Clinical Trial for Metastatic Colorectal Cancer
            • Type of Clinical Practice
        • Appendix
          • Country-Specific Reimbursement Background Details
            • France: Key Background Details of the Healthcare System
            • France: P&R Process
            • France: P&R Process
            • Germany: Key Background Details of the Healthcare System
            • Germany: P&R Process
            • Germany: P&R Process
            • Italy: Key Background Details of the Healthcare System
            • Italy: P&R Process
            • Italy: P&R Process
            • Italy: Additional Funding Mechanisms for Off-Label Use
            • Spain: Key Background Details of the Healthcare System
            • Spain: P&R Process
            • Spain: P&R Process
            • Spain: HTA Bodies
            • Spain: Autonomic Evaluation Committees
            • Spain: Autonomic Evaluation Committees (CAEs)
            • Spain: Commissions for Pharmacy and Therapeutics
            • Spain: Commissions for Pharmacy and Therapeutics
            • United Kingdom: Key Background Details of the Healthcare System
            • United Kingdom: P&R Process
            • United Kingdom: P&R Process
            • United Kingdom: Reimbursement Details and Budget Control
          • Key Current and Emerging Therapies for Metastatic Colorectal Cancer
            • Profiles of Key Drugs for Metastatic Colorectal Cancer in the EU5
            • Emerging Therapy Profiles
            • Merck & Co.'s Keytruda (pembrolizumab)
            • Array BioPharma, Pierre Fabre, and Merck KGaA's Binimetinib and Encorafenib
            • Roche's Tecentriq (atezolizumab) and Cotellic (cobimetinib)
          • Physician Survey Data
            • Factors Influencing Prescribing of Avastin for Metastatic Colorectal Cancer
            • Factors Influencing Prescribing of Erbitux for Metastatic Colorectal Cancer
            • Funding of Cyramza in Light of Possible Reimbursement Hurdles
            • Funding of Stivarga in Light of Possible Reimbursement Hurdles
            • Funding of Lonsurf in Light of Possible Reimbursement Hurdles
            • Clinical and Nonclinical Factors Restricting Prescribing of Avastin for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Clinical and Nonclinical Factors Restricting Prescribing of Zaltrap for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Clinical and Nonclinical Factors Restricting Prescribing of Cyramza for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Clinical and Nonclinical Factors Restricting Prescribing of Stivarga for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Clinical and Nonclinical Factors Restricting Prescribing of Erbitux for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Clinical and Nonclinical Factors Restricting Prescribing of Vectibix for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Clinical and Nonclinical Factors Restricting Prescribing of Lonsurf for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Factors Expected to Limit Prescribing of Keytruda for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Factors Expected to Limit Prescribing of Binimetinib Plus Encorafenib and Erbitux for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Factors Expected to Limit Prescribing of Tecentriq Plus Cotellic for Metastatic Colorectal Cancer: Prescribers Versus Nonprescribers
            • Impact of Richtgrößen on Patient Access to Avastin for Metastatic Colorectal Cancer in Germany
            • Impact of Richtgrößen on Patient Access to Zaltrap for Metastatic Colorectal Cancer in Germany
            • Impact of Richtgrößen on Patient Access to Cyramza for Metastatic Colorectal Cancer in Germany
            • Impact of Richtgrößen on Patient Access to Stivarga for Metastatic Colorectal Cancer in Germany
            • Impact of Richtgrößen on Patient Access to Erbitux for Metastatic Colorectal Cancer in Germany
            • Impact of Richtgrößen on Patient Access to Vectibix for Metastatic Colorectal Cancer in Germany
            • Impact of Richtgrößen on Patient Access to Lonsurf for Metastatic Colorectal Cancer in Germany
            • Impact of Added Benefit Rating on the Prescribing of Premium-Priced Oncology Drugs in France and Germany
            • Impact of Therapeutic Benefit and Ultimate Innovation Rating on the Prescribing of Premium-Priced Agents in Italy
            • Impact of Lobbying the CFT of Hospitals to Include Premium-Priced Oncology Agents on Their Formulary in Spain
            • Anticipated Success of the Redesign of the CDF in the United Kingdom

      Author(s): Yulia Privolnev, MA

      Yulia Privolnev is a manager on the Global Market Access Insights team at Decision Resources Group, primarily focusing on European market access. She is responsible for monitoring, analyzing, and reporting on global market access through the production of DRG’s Global Market Access Solution (GMAS) and Access & Reimbursement products. Yulia’s specific focus is on all aspects of market access in Western and Eastern Europe, as well as external reference pricing (ERP) and managed entry agreements (MEAs) on a global scale. Yulia holds a bachelor’s degree from the University of Toronto and a master’s degree from the London School of Economics.


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