The increase in oral oncolytics has fueled an increase in physician dispensing of drugs either from the office or from a pharmacy owned by the practice or hospital, as allowed by state laws. Direct dispensing enables physicians to more comprehensively manage their patients’ medical and therapeutic needs and provides an extra revenue stream. However, some managed care organizations (MCOs) are concerned that physician dispensing diverts prescriptions from their specialty pharmacy or from their pharmacy benefit manager’s contracted specialty pharmacy. Understanding physician dispensing and its effect on payer reimbursement and on oncologists’ and urologists’ prescribing habits is essential to creating a sound market-access strategy for drugs to treat prostate cancer and other cancers with oral options.
- How common is it for oncologists and urologists to dispense oral prostate cancer drugs─ such as Janssen’s Erleada and Zytiga and Pfizer’s Xtandi─from within their practices or in-house dispensing pharmacies?
- What advantages do physicians report from in-office dispensing?
- How do MCOs view and react to in-office dispensing, and how does its affect physician reimbursement?
- What is the coverage and prescribing environment for metastatic castrate-resistant prostate cancer (mCRPC) therapies in general, including the IV agents Provenge, Xofigo, and Jevtana?
- What is the market access outlook for emerging therapies for nonmetastatic castrate-resistant prostate cancer (nmCRPC), including Erleada and Xtandi, as well as Bayer HealthCare/Orion’s darolutamide?
Access & Reimbursement provides in-depth insight regarding the impact of payer policy on physician prescribing behavior so that clients can build their market access strategy and optimize their brand positioning.
- Survey of 50 medical oncologists and 51 urologists in the United States.
- Survey of 40 U.S. MCO pharmacy and medical directors.
KEY DRUGS COVERED
Erleada, Jevtana, Provenge, Xofigo, Xtandi, Zytiga, darolutamide
- Reimbursement and contracting.
- Access and prescribing.
- Special topic: in-office dispensing of oral therapies.
- Opportunities and challenges for emerging therapies.
- Prostate Cancer - Access & Reimbursement - Detailed, Expanded Analysis (US): Physician Dispensing Of Oral Oncolytics In Prostate Cancer
Author(s): Chris Lewis
Chris Lewis serves as primary research manager, U.S. Access and Reimbursement, with responsibility for coordination, content review and content generation of the market access and reimbursement insights at DRG. Content is based on online surveys of managed care organizations and physicians and expert analysis of reimbursement and prescribing patterns of key therapies treating various disease states.
Lewis was an analyst/senior analyst for the group’s HealthLeaders-InterStudy subsidiary for eight years, specializing in the managed care and pharmacy benefit management industries. Throughout her tenure, she has produced the Health Plan Analysis reports for California, New York, New Jersey, Connecticut, and Pennsylvania and authored DRG’s series of pharmacy benefit manager profiles. She has also conducted numerous webinars for the group. She is a seasoned journalist with a B.A. in communications from California State University, Sacramento.