Non-small-cell lung cancer (NSCLC) affects thousands of individuals in Brazil and Mexico, and it is managed with premium-priced targeted agents and chemotherapy. In both countries, public coverage is extremely limited, compared with more robust coverage in the private setting. 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 NSCLC 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 NSCLC in Brazil and Mexico explores the prescribing patterns for current 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 targeted therapies over the next two to three years. This content draws on insights from 100 surveyed physicians and from interviews with 6payers in Brazil and Mexico, all of whom have influence at the regional, institutional, 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 targeted therapies for NSCLC, 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 Tarceva or Iressa, or newer agents such as Zykadia or Opdivo?
  • What will be the impact of biosimilars of bevacizumab in the prescription of Avastin and other premium-priced agents?
  • What clinical benefits are physicians and payers looking for in emerging therapies such as Tafinlar + Mekinist or Keytruda in Brazil, and what kind of savings in direct and indirect costs are payers seeking?

Table of contents

  • Non-Small-Cell Lung Cancer - Access & Reimbursement - Detailed, Expanded Analysis (Brazil And Mexico)
    • Key Updates
      • September 2017
    • Market Access Overview
      • Actionable Recommendations to Optimize Market Access
        • Optimizing Market Access Opportunity for New Non-Small-Cell Lung Cancer Therapies in Brazil and Mexico
      • Successes and Stumbles
        • Successes Among Non-Small-Cell Lung Cancer Therapies in Brazil and Mexico
        • Stumbles Among Non-Small-Cell Lung Cancer Therapies in Brazil and Mexico
        • Brazil: Coverage Successes and Stumbles
          • Mexico: Coverage Successes and Stumbles
          • Key Stakeholders in the Road to Market Access
            • Brazil
            • Mexico
          • Key Market Access Roadblocks
            • Key Market Access Roadblocks for Non-Small-Cell Lung Cancer Therapies in Brazil and Mexico
            • Brazil: Key Market Access Roadblocks
            • Mexico: Key Market Access Roadblocks
          • Reimbursement Dynamics
            • Brazil: Coverage Dynamics for Non-Small-Cell Lung Cancer
              • Brazil: HTA Process
              • Brazil: Drivers of Formulary Coverage for Non-Small-Cell Lung Cancer Drugs
              • Brazil: Coverage and HTA Details
              • Brazil: Key Background Details of the Healthcare System
            • Mexico: Coverage Dynamics for Non-Small-Cell Lung Cancer
              • Mexico: HTA Process
              • Mexico: Drivers of Formulary Coverage for Non-Small-Cell Lung Cancer Drugs
              • Mexico: Coverage Details
              • Interinstitutional CByCM Updates in 2017
              • Mexico: Lessons Learned and Key Takeaways
              • Mexico: Key Background Details of the Healthcare System
          • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
            • Prescriber Preferences for First-Line Treatments for Nonsquamous EGFR-Wild-Type/Unknown and ALK-Translocation-Negative/Unknown Non-Small-Cell Lung Cancer
              • Prescriber Preferences for First-Line Treatments for Nonsquamous EGFR-Wild-Type/Unknown and ALK-Translocation-Negative/Unknown Non-Small-Cell Lung Cancer
            • Prescriber Preferences for Second and Third-Line Recurrent Metastatic/Advanced Nonsquamous Non-Small-Cell Lung Cancer
              • Prescriber Preferences for Second-Line Recurrent Metastatic/Advanced Nonsquamous Non-Small-Cell Lung Cancer
              • Prescriber Preferences for Third-Line Recurrent Metastatic/Advanced Nonsquamous Non-Small-Cell Lung Cancer
            • Prescriber Preferences for First-Line EGFR-Mutated Non-Small-Cell Lung Cancer
              • Prescriber Preferences for First-Line ALK-Translocation-Positive Non-Small-Cell Lung Cancer
                • Impact of Payer Policy on Prescribing for Non-Small-Cell Lung Cancer
                  • Percentage of Non-Small-Cell Lung Cancer Patients Receiving Treatment
                  • Percentage of Treatment-Eligible Patients Not Receiving Key Treatments Due to Budgetary/Reimbursement Reasons
                  • Mexico: Top Coverage/Reimbursement and Cost Restrictions Limiting Prescribing for Treatment-Eligible Non-Small-Cell Lung Cancer Patients
                  • Brazil: Top Coverage/Reimbursement and Cost Restrictions Limiting Prescribing for Treatment-Eligible Non-Small-Cell Lung Cancer Patients
                  • Most Common Access Routes to Targeted Therapies When Unavailable or Uncovered
                  • Oncologists' Willingness to Prescribe Biosimilars
                  • Impact of Payer Policy on Prescribing for Non-Small-Cell Lung Cancer: Changes in Prescribing Without Access Barriers
                  • Oncologists' Choice of First-Line Treatments in the Absence of Access Barriers According to PD-L1 Status
                  • Oncologists' Choice of First-Line Treatment for EGFR-Mutated and ALK-Translocation-Positive Non-Small-Cell Lung Cancer in the Absence of Access Barriers
                  • Oncologists' Choice of Second- and Third-Line Treatments for Nonsquamous Non-Small-Cell Lung Cancer in the Absence of Access Barriers
                • Top Prescribing Drivers: Non-Small-Cell Lung Cancer
                  • Top Prescribing Drivers: First-Line ALK-Translocation-Positive Patients
                  • Attitudes on Prescribing PD-1/PD-L1 Pathway Inhibitors for Nonsquamous Non-Small-Cell Lung Cancer
                • Key Levers and Constraints on Current Therapies
                  • Key Levers and Constraints on Current Therapies
              • Market Access Landscape for Emerging Therapies
                • Likely Impact of Emerging Therapies for Non-Small-Cell Lung Cancer
                  • Oncologists' Willingness to Prescribe Emerging Therapies
                  • Drivers and Preferences to Prescribe Tafinlar + Mekinist
                • Market Access Challenges for Emerging Therapies for Non-Small-Cell Lung Cancer
                  • Expected Choices of First-Line Treatments for EGFR-Wild-Type/Unknown and ALK-Translocation-Negative/Unknown Non-Small-Cell Lung Cancer Patients
                  • Expected Choices of First-Line Treatments for EGFR-Mutated Non-Small-Cell Lung Cancer Patients
                  • Expected Choices of First-Line Treatments for ALK-Translocation-Positive Non-Small-Cell Lung Cancer Patients
                • Payer Opinion on Emerging Therapies for Non-Small-Cell Lung Cancer
                  • Brazil: Payer Opinion on Emerging Therapies for Non-Small-Cell Lung Cancer
                  • Mexico: Payer Opinion on Emerging Therapies for Non-Small-Cell Lung 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 post-residency?
                  • How would you best describe the setting(s) in which you practice?
                  • How many adult patients (aged 18 or older) with NSCLC do you see (i.e., 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?
                  • Experience Prescribing Drugs for Non-Small-Cell Lung Cancer Outside of Clinical Trials
                • Pricing Methodology
              • Appendix
                • Commercial Context
                  • Epidemiology: Diagnosed Incidence of Non-Small-Cell Lung Cancer in Brazil and Mexico
                  • Treatment Guidelines for Non-Small-Cell Lung Cancer in Brazil
                  • Treatment Guidelines for Non-Small-Cell Lung Cancer in Mexico
                  • Treatment Guidelines for Non-Small-Cell Lung Cancer in Mexico
                  • Sources of Treatment Guidelines for Non-Small-Cell Lung Cancer
                  • Profiles of Key Drugs for Non-Small-Cell Lung Cancer in Brazil and Mexico
                  • Advantages and Disadvantages of Key Drugs for Non-Small-Cell Lung Cancer
                  • Price per 28 Days of Treatment with Key Non-Small-Cell Lung Cancer Drugs
                  • Brazil: APAC Values
                  • Brazil: APAC Values
                  • Timeline of Approvals of Key Current and Emerging Therapies
                  • Key Finding for Keytruda
                  • Merck's Pembrolizumab (shown only to Brazil)
                  • Key Finding for Tafinlar + Mekinist
                  • Novartis's Tafinlar + Mekinist
                  • Key Finding for Zykadia
                  • Novartis's Ceritinib (shown only to Brazil)
                  • Brazil: Productive Development Partnerships
                • Physician Survey Data
                  • Percentage of Non-Small-Cell Lung Cancer Patients Receiving Treatment
                  • Brazil: Formulary Inclusion of Key Therapies for Non-Small-Cell Lung Cancer
                  • Mexico: Formulary Inclusion of Key Therapies for Non-Small-Cell Lung Cancer
                  • Mexico: Formulary Inclusion of Key Therapies for Non-Small-Cell Lung Cancer (cont.)
                  • Percentage of Patients Not Receiving Key Treatments Due to Budgetary/Reimbursement Reasons
                  • Coverage/Reimbursement and Cost Restrictions Limiting Prescribing of EGFR Inhibitors for Treatment-Eligible Non-Small-Cell Lung Cancer Patients
                  • Coverage/Reimbursement and Cost Restrictions Limiting Prescribing for Treatment-Eligible Non-Small-Cell Lung Cancer Patients
                  • Common Access Routes to EGFR Inhibitors when Unavailable or Uncovered
                  • Common Access Routes to Non-Small-Cell Lung Cancer Key Agents When Unavailable or Uncovered
                  • Brazil: Reimbursement Under the APAC
                  • Brazil: Reimbursement Under the APAC: Impact of the APAC Paulista
                  • Biomarker Testing
                  • Average Turnaround Time for Biomarker Testing
                  • Expected Patient Shares for Biosimilars in Non-Small-Cell Lung Cancer Patients Two Years After the Biosimilar’s Launch
                  • Oncologists’ Reasons for Not Prescribing Biosimilars Within Two Years of Launch
                  • Brazil: Impact of Availability of Bevacizumab Biosimilar on Public Patients' Access
                  • Oncologists Prescription of Immune Checkpoint Inhibitors to Nonsquamous Non-Small-Cell Lung Cancer Patients
                  • Reasons for Not Prescribing Immune Checkpoint Inhibitors for Nonsquamous Non-Small-Cell Lung Cancer Patients
                  • Patient Shares for First-Line Nonsquamous Metastatic EGFR-Wild-Type/Unknown and ALK-Translocation-Negative/Unknown Non-Small-Cell Lung Cancer
                  • Patient Shares for Second- and Third-Line Recurrent Metastatic/Advanced Nonsquamous Non-Small-Cell Lung Cancer
                  • Preferred Immune Checkpoint Inhibitors for PD-L1-Positive Non-Small-Cell Lung Cancer Patients
                  • Attitudes on Prescribing PD-1/PD-L1 Pathway Inhibitors for Nonsquamous Non-Small-Cell Lung Cancer
                  • Oncologists' Choice of First-Line Treatments for EGFR-Wild-Type/Unknown and ALK-Translocation-Negative/Unknown Non-Small-Cell Lung Cancer in the Absence of Access Barriers
                  • Oncologists' Choice of Second- and Third-Line Treatments for Nonsquamous Non-Small-Cell Lung Cancer in the Absence of Access Barriers
                  • Patient Shares for First-Line ALK-Translocation-Positive Non-Small-Cell Lung Cancer
                  • Patient Shares for First-Line EGFR-Mutated Non-Small-Cell Lung Cancer
                  • Prescribing Drivers for Key Drugs as First-Line Treatment of Choice of ALK-Translocation-Positive Non-Small Cell Lung Cancer Patients
                  • Prescribing Drivers for Avastin as First-Line Treatment of Choice of ALK-Translocation-Positive Non-Small-Cell Lung Cancer Patients
                  • Prescribing Drivers for Keytruda as First-Line Treatment of Choice of ALK-Translocation-Positive Non-Small-Cell Lung Cancer Patients
                  • Prescribing Drivers for Chemotherapy as First-Line Treatment of Choice of ALK-Translocation-Positive Non-Small-Cell Lung Cancer Patients
                  • Prescribing Drivers for Xalkori as First-Line Treatment of Choice of ALK-Translocation-Positive Non-Small-Cell Lung Cancer Patients
                  • Oncologists' Choice of First-Line Treatment for EGFR-Mutated and ALK-Translocation-Positive Non-Small-Cell Lung Cancer in the Absence of Access Barriers
                  • Oncologists' Willingness to Prescribe and Recommend Coverage for Emerging Therapies Once Approved
                  • Drivers and Preferences to Prescribe Emerging Therapies
                  • Expected Choices of First-Line Treatments for ALK-Translocation-Positive Non-Small-Cell Lung Cancer Patients
                  • Expected Choices of First-Line Treatments for EGFR-Mutated Non-Small-Cell Lung Cancer Patients
                  • Expected Choices of First-Line Treatments for EGFR-Wild-Type/Unknown and ALK-Translocation-Negative/Unknown Non-Small-Cell Lung 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.


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