Immune checkpoint inhibitors have revolutionized the treatment of multiple oncology indications but the high costs associated with these agents present significant challenges for payers. The potential for label expansions into additional indications and combinatorial approaches involving immune checkpoint inhibitors will put further pressure on MCO commercial plans. Developing a clear understanding of the reimbursement landscape and effect on prescribing is critical for maximizing commercialization of immune checkpoint inhibitors. This content examines the current and future reimbursement dynamics for immune checkpoint inhibitors in the United States with a focus on key indications— malignant melanoma, bladder cancer, and squamous cell carcinoma of the head and neck (SCCHN).

Questions Answered:

  • What role do immune checkpoint inhibitors play in the treatment of oncology indications such as malignant melanoma, bladder cancer, and SCCHN? In what treatment settings are they mostly prescribed?
  • How broadly do MCOs cover immune checkpoint inhibitors on their formularies and what kind of restrictions do they use to control usage? Do access and reimbursement challenges for immune checkpoint inhibitors differ by indication?
  • Do payers believe the efficacy of the immune checkpoint inhibitors justifies their cost, and which drug do they think performs the best on clinical and other attributes?
  • What are physicians’ views on emerging immune checkpoint inhibitors in late-stage development ? How do clinicians expect prescribing to change in the future, and what factors, if any, will drive these changes?

Product Description

Access & Reimbursement: Provides in-depth insight regarding 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

  • Immune Checkpoint Inhibitors - Access & Reimbursement - Detailed, Expanded Analysis (US)

Author(s): Jorrit Schäfer, M.Sc., Ph.D.

Jorrit Schäfer, M.Sc., Ph.D., is a business insights analyst at Decision Resources Group. Prior to joining DRG, Dr. Schäfer worked as a postdoctoral research associate at Imperial College London, where he studied the impact of antibiotic stress on RNA repair in bacteria. Dr. Schäfer holds a M.Sc. in molecular medicine and a Ph.D. in molecular cell biology from Imperial College London.