Immune checkpoint inhibitors have revolutionized the treatment of multiple oncology indications, including non-small-cell lung cancer (NSCLC), malignant melanoma, and bladder cancer. As premium-priced immune checkpoint inhibitors gain label expansions for additional indications, and approvals as part of combinatorial regimens, the high cost associated with these agents will continue to present significant challenges for payers. Developing a clear understanding of prescribing patterns and the reimbursement landscape for immune checkpoint inhibitors is critical to maximize commercial success.

QUESTIONS ANSWERED

  • What role do immune checkpoint inhibitors play in the treatment of oncology indications such as NSCLC, malignant melanoma, and bladder cancer?
  • What are the key driving forces and constraints that influence MCO reimbursement decisions for immune checkpoint inhibitors?
  • Do access and reimbursement challenges for these agents differ by indication?
  • How do payers prioritize diminishing budgets and control prescribing of immune checkpoints accordingly?
  • What are medical oncologists’ views on select emerging immune checkpoint inhibitors in late-phase development?

GEOGRAPHY: United States.

PRIMARY RESEARCH: Survey of 100 U.S. medical oncologists and 30 U.S. managed care organization (MCO) pharmacy directors and medical directors (PDs/MDs).

KEY DRUGS COVERED: Keytruda, Opdivo, Yervoy, Tecentriq, Imfinzi, Bavencio.

CONTENT HIGHLIGHTS:

  • Actionable recommendations to optimize market access.
  • Market access successes and stumbles.
  • Reimbursement and contracting.
  • Access and prescribing.
  • Special topics.
  • Opportunities and challenges for emerging therapies.

Table of contents

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

Author(s): Neela Rambaruth; Chris Lewis; Dana Gheorghe

Neela Rambaruth is a Business Insights Analyst in the Oncology division at DRG. Neela joined DRG in 2018 and has since authored the Disease Landscape and Forecast report for non-small-cell lung cancer. Neela is currently working on the Disease Landscape and Forecast report for Hepatocellular carcinoma and the survey for Immune checkpoint US Access and Reimbursement.

Prior to joining DRG, Neela Rambaruth was a Postdoctoral Scientist at University College London, where she investigated the interaction of novel drugs with a therapeutic receptor involved in cardiovascular disease.  She also held another postdoctoral position at Imperial College London, where she studied host-pathogen interaction in tuberculosis. Dr Rambaruth holds a PhD in Breast Oncology from the University of Westminster.  Her doctorate focused on the identification of novel biomarkers associated with metastatic breast cancer. She has also published several peer-reviewed articles in oncology and therapeutic drug discovery.

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.

Dana Gheorghe, Ph.D., is a senior business insights analyst on the Oncology team at Decision Resources Group, specializing in non-Hodgkin’s lymphoma and renal cell carcinoma, with expertise in multiple myeloma and metastatic colorectal cancer. Her previous experience includes postdoctoral positions at Imperial College London and the Marie Curie Research Institute. Dr. Gheorghe holds a Ph.D. in cellular biology and biochemistry from the University of Sheffield and a B.Sc./Honors in Molecular Biology from the University of Edinburgh.