Biomarker-driven prescribing is paramount in key oncology indications. Biomarkers play an important role and are well-entrenched in indications such as non-small-cell lung cancer and malignant melanoma and are playing an increasingly important role in indications such as gastroesophageal cancer. While biomarker-associated therapies offer the advantage of selecting the patients most likely to respond to treatment, these therapies are premium-priced and often subject to payer restrictions and cost-containment strategies. We explore the drivers and barriers to use of these agents and report on how reimbursement impacts drug selection and prescribing. We also evaluate surveyed medical oncologists’ and surveyed payers’ perceptions of emerging biomarker-driven therapies in select solid-tumor indications.
- What factors most influence payers’ reimbursement decisions for biomarker-driven therapies in NSCLC, malignant melanoma, and gastroesophageal cancer? What restrictions do they impose?
- Do access and reimbursement challenges differ by indication and/or how well-established the biomarker is in each indication?
- What role do reimbursement and cost play in oncologists’ decisions to prescribe biomarker-driven therapies?
- What are payer opinions of emerging agents and how will oncologists’ prescribing patterns change with the launch of new therapies?
- What factors influence reimbursement and access of companion biomarker tests?
- Geography: United States.
- Primary research: Survey of 100 U.S. medical oncologists and 30 U.S. managed care organization (MCO) pharmacy directors (PDs).
- Key drugs covered: Keytruda, Opdivo, Yervoy, Xalkori, Zykadia, Gilotrif, Tagrisso, Portrazza, Zelboraf, Tafinlar, Cotellic, Mekinist, Herceptin, and others.
U.S. Access & Reimbursement provides in-depth insight on the impact of payer policy on prescribing behavior so that clients can build their market access strategy and optimize their brand positioning. This analysis of primary market research with physician specialists and U.S. payers helps clients stay up-to-date on restriction policies, gauge payer and prescriber attitudes toward specific therapies, identify opportunities where brands can capture patient share through market access, and maximize opportunities for emerging therapies by learning how previous brands gained favorable reimbursement or why they stumbled.
- Biomarkers In Oncology - Access & Reimbursement - Detailed, Expanded Analysis: Multi-indication (US)
Author(s): Laura Vinuesa, DVM, MSc
Laura Vinuesa, DVM, M.Sc., is a Senior Business Insights Analyst in the Oncology Division at Decision Resources Group, with expertise in thyroid carcinoma and bladder cancer. Previously, Dr. Vinuesa was an EU Market Access Analyst in the Global Market Access Insights Team at Decision Resources Group. She has expertise in market access, pricing and reimbursement, health technology assessment, and health policy.
Prior to joining Decision Resources, she worked as Market Access & Institutional Relations Analyst at Pfizer in Spain, providing support for the successful market launch of drugs for different areas: cardiovascular, oncology, mental disorder and rare disease. She is a Doctor of Veterinary Medicine from the Complutense University of Madrid, and holds a M.Sc. in Clinical Research and Pharmaceutical Medicine from EPHOS - School of PharmaStudies.