The treatment of both solid and hematological cancers is associated with a wide range of serious side effects, including chemotherapy-associated neutropenia and anemia, nausea and vomiting, and oral mucositis. In addition to some of these adverse events being life-threatening, they have a significant detrimental impact on patients’ quality of life and often require dose delays, dose reductions, or cessation of cancer treatment, thereby compromising outcomes. As a result, the optimal treatment of chemotherapy-related side effects using supportive care therapies is an integral part of good cancer patient care.  Clinical factors play a critical role in supportive therapy choice, but payer restrictions also shape prescribing decisions. Emerging therapy and biosimilar pricing will have a significant impact on MCO coverage in commercial plans in the near future. A significantly lower price than the standard of care features prominently among the top most important attributes for development of new supportive care therapies, both according to surveyed payers and physicians.

Table of contents

  • Supportive Care In Oncology - Access & Reimbursement - Detailed, Expanded Analysis (US)
    • Introduction
      • Actionable Recommendations to Optimize Market Access
        • Successes and Stumbles
          • Overview of Successes and Stumbles for Oncology Supportive Care
          • Successes Among Oncology Supportive Care Therapies in the United States: Physicians
          • Stumbles Among Oncology Supportive Care Therapies in the United States: Physicians
          • Successes Among Oncology Supportive Care Therapies in the United States: MCOs
          • Stumbles Among Oncology Supportive Care Therapies in the United States: MCOs
          • Best-Performing Agents for Chemotherapy-Associated Neutropenia in Terms of Market Access Themes
          • Best-Performing Agents for Chemotherapy-Associated Anemia in Terms of Market Access Themes
          • Best-Performing NK1 Receptor Antagonist Brands for CINV in Terms of Market Access Themes
          • Best-Performing Agents for Oral Mucositis in Terms of Market Access Themes
        • Key Stakeholders in the Road to Market Access
          • Stakeholder Influence on Physician Prescribing
          • Healthcare Coverage in the United States
          • Healthcare Coverage in United States
          • United States: Stakeholder Dynamics in the Road to Reimbursement
          • Major Commercial Insurers in the United States
        • Key Market Access Roadblocks
          • Reimbursement Dynamics
            • United States: Commercial Managed Care Organizations
              • Lessons Learned and Key Takeaways
              • Current Reimbursement of Select Supportive Care Therapies in Oncology
              • Reimbursement of Select Supportive Care Therapies in Oncology in 12 Months' Time
              • Pricing and Reimbursement Drivers
              • Key Findings - Pricing & Reimbursement
              • MCO Drivers of Reimbursement for Febrile Neutropenia
              • MCO Drivers of Reimbursement for Chemotherapy-Associated Anemia
              • Best-Performing Agents for Chemotherapy-Associated Neutropenia According to Payers
              • MCO Drivers of Reimbursement for CINV
              • MCO Drivers of Reimbursement for Oral Mucositis Associated with Chemotherapy
              • Value Assessment and Pharmacoeconomics
              • Preferred Pharmacoeconomic Models for Emerging Supportive Care Therapies in Oncology
              • Contracting Agreements for Chemotherapy-Induced Neutropenia Therapies
              • Contracting Agreements for Chemotherapy-Induced Anemia Therapies
              • Cost-Sharing for Key Supportive Care Therapies in Oncology
              • Copay and Coinsurance Rates for Supportive Care Therapies in Oncology
              • Restrictions Used in Commercial Plans
              • Prior Authorization Restrictions for Supportive Care Therapies in Oncology
              • Impact of Prior Authorization
              • Current Reimbursement of Zarxio
              • Current Zarxio Coverage
              • Reasons for Placing Zarxio on a Nonpreferred Tier
              • Conditions for Placing Zarxio on Preferred Tier
          • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
            • Patient Share in Key Payer Channel
              • Key Findings
              • Patient Shares of Myeloid Growth Factors
              • Shares of NK1 Receptor Antagonists Among HEC-Treated Patients with CINV
              • Shares of NK1 Receptor Antagonists Among MEC-Treated Patients with CINV
              • Patient Shares of Select Oral Mucositis Therapies
              • Treatment Decision Drivers
              • Factors Affecting Choice of Therapy for Chemotherapy-Associated Neutropenia
              • Factors Affecting Choice of Therapy for Chemotherapy-Associated Anemia
              • Factors Affecting Choice of Therapy for CINV
              • Factors Affecting Choice of Therapy for Oral Mucositis
            • Prescriber Preference
              • Prescriber Preferences for Supportive Therapies in Oncology
              • Impact of Payer Strategies on Prescribing of Therapies for Chemotherapy-Associated Neutropenia
              • Impact of Payer Strategies on Prescribing of Therapies for Chemotherapy-Associated Anemia
              • Impact of Payer Strategies on Prescribing of Therapies for CINV
              • Impact of Payer Strategies on Prescribing of Therapies for Oral Mucositis
            • Impact of Restrictions on Prescribing
              • Payer Policy Impact on Prescribing: Key Findings
              • Payer-Imposed Cost Controls That Restrict Prescribing of Supportive Care Therapies in Oncology
          • Market Access Landscape for Emerging Therapies
            • Impact of Emerging Therapies on Prescribing
              • Likely Impact of Emerging Supportive Care Therapies
              • Physicians' Anticipation of Best-Performing Emerging Therapies for Oral Mucositis
              • Patient Shares of Chemotherapy-Induced Anemia Agents If Luspatercept Is on a Preferred vs. Nonpreferred Tier
              • Patient Shares of Oral Mucositis Agents If Emerging Therapies Are on a Preferred vs. Nonpreferred Tier
            • Impact of Emerging Biosimilars on Prescribing
              • Physician ESA Preference
              • Physician Willingness to Prescribe Biosimilar Epoetin Alfa
              • Physician Pegfilgrastim Preference
              • Physician Willingness to Prescribe Pegfilgrastim Biosimilars
            • Potential Placement of Emerging Therapy at Various Prices
              • Potential Reimbursement of Emerging Supportive Care Therapies
              • Potential Tier Placement of Luspatercept at Various Price Points
              • Potential Tier Placement of Brilacidin at Various Price Points
            • Reimbursement of Biosimilars
              • Potential Placement of Biosimilars
              • Likelihood of Coverage for Emerging Biosimilars
              • Minimal Acceptable Discount Against Brand for Preferred Coverage of Biosimilar Pegfilgrastim
              • Minimal Acceptable Discount Against Brand for Preferred Coverage of Biosimilar Epoetin Alfa
              • Strategies for Encouraging Use of Emerging Biosimilars
            • Prescriber and MCO Priorities for Emerging Therapy Evaluation
              • Key Findings
              • Most Important Attributes for Development of Emerging Supportive Care Therapies in Oncology: MCOs
              • Most Important Attributes for Development of Emerging Supportive Care Therapies in Oncology: Physicians
          • Methodology
            • Primary Market Research Methodology: Physicians
              • What is your specialty?
              • How many years have you practiced postresidency?
              • How many patients with the following indications do you treat per month?
              • How many of your cancer patients are treated for anemia, neutropenia, CINV, and oral mucositis every month?
              • Where is your practice based primarily?
              • In what region is your practice located?
              • How many of your cancer patients have the following insurance coverage or are uninsured?
            • Primary Market Research Methodology: MCOs
              • Are you an MCO pharmacy or medical director?
              • In what region is your managed care firm located?
              • Which of the following best describes the operations of your MCO?
              • Which of the following health plans does your company offer?
              • How many covered lives (prescription and medical benefit) does your MCO manage?
              • How many individual lives (prescription and medical benefit) does your MCO cover?
          • Appendix
            • Physician Survey
              • Percentage of Physicians Who Prescribe Select Supportive Care Therapies
              • Physician-Reported Commercially Covered Supportive Care Therapies
              • Factors That Limit Prescribing for Chemotherapy-Associated Neutropenia
              • Best-Performing Agents for Chemotherapy-Associated Neutropenia in Terms of Clinical Factors
              • Factors That Limit Prescribing for Chemotherapy-Associated Anemia
              • Patient Shares of Erythropoiesis-Stimulating Agents
              • Best-Performing ESA Brands for Chemotherapy-Associated Anemia in Terms of Clinical Factors
              • Step Therapy Conditions for Supportive Care Agents
              • Factors That Will Restrict Prescribing of Luspatercept
              • Factors That Limit Prescribing for CINV
              • Best-Performing NK1 Receptor Antagonist Brands for CINV in Terms of Clinical Factors
              • Factors That Limit Prescribing for Oral Mucositis
              • Best-Performing Brands for Oral Mucositis in Terms of Clinical Factors
              • Factors That Will Restrict Prescribing of Brilacidin
            • MCO Survey
              • Strategies Used to Manage Utilization and/or Cost of Supportive Care Therapies
              • Reasons for Not Reimbursing Supportive Care Therapies
              • Time Between Supportive Care Therapy Launch and P&T Committee Review/Decision on UM Criteria
              • Entities Responsible for Formulary Development and Maintenance and for Contracting with Pharmaceutical Manufacturers
              • Types of PBM Formularies
              • Degree of Formulary Customization
              • Interim Status Applied to FDA-Approved Supportive Care Therapies Pending Complete Formulary Review
              • P&T Committee Members with Greatest Influence on Formulary Decisions for Supportive Care Therapies
              • Items Needed for P&T Committee Review of Supportive Care Therapies
              • Most Common Coinsurance for Supportive Care Therapies
              • Most Common Copayment for Supportive Care Therapies
              • Management of Specialty Drugs for Supportive Care
              • Presence of OOP Maximum for Specialty Tier Supportive Care Therapies
              • Step Edits for Myeloid Growth Factors Subject to Step Therapy
              • Step Edits for ESAs Subject to Step Therapy
              • Reimbursed Settings for Myeloid Growth Factors
              • Payer Agreement with Statements Regarding Subcutaneous Neulasta and Naulasta OnPro
              • Average Rebate for Supportive Care Therapies
              • Reasons for Not Reimbursing Zarxio
              • Impact of Biosimilar Tier Placement for Zarxio
              • Overview of Pharmacoeconomic Models
              • Highest Acceptable ICER per QALY for Supportive Care Indications
              • Comparators of Noninferiority and Cost in Chemotherapy-Associated Neutropenia
              • Comparators of Noninferiority and Cost in Chemotherapy-Associated Anemia
              • Comparators of Noninferiority and Cost in CINV
              • Comparators of Noninferiority and Cost in Oral Mucositis
              • Most Compelling Pharmacoeconomic Data for Emerging Supportive Care Therapies
              • Impact of Pharmacoeconomic Data on Formulary Coverage
              • Factors Influencing Formulary Placement of Supportive Care Therapies
            • About Decision Resources Group
              • Authors biography
              • Author(s) Picture

        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.


        Related Reports

        Biosimilars - Market Events And Forecast - Oncology

        In 2019, sales of branded monoclonal antibody biologics in oncology exceeded $18 billion across the major markets (United States, EU5, and Jap...

        View Details

        Biomarkers In Oncology - Access & Reimbursement - Detailed, Expanded Analysis (US) Biomarkers In Oncology

        Biomarkers have become an integral component of the treatment landscape for an increasing number of oncology indications. Patients’ biomarker status often directs prescription choice in malig...

        View Details

        Biosimilars - Geographic Focus: China - Biosimilars | China In-Depth | Oncology And Immunology | China

        The approval of Shanghai Henlius Biotech's HLX01—a biosimilar of Roche's Rituxan (rituximab)—in February 2019 marked the beginning of the biosimilars era in China. Since then, b...

        View Details

        Biosimilars - Emerging Biosimilars - Special Topics: Oncology Biosimilars In The United States - Wave 2

        Biosimilars referencing Roche/Genentech’s portfolio of blockbuster oncology monoclonal antibodies—Avastin, Herceptin, and Rituxan—launched in the United States throughout the seco...

        View Details