Non-Hodgkin’s lymphoma (NHL) encompasses a plethora of subtypes with varying prognoses, and the treatment landscape is entrenched with targeted agents. Roche’s Rituxan, Janssen / AbbVie’s Imbruvica, and AbbVie / Roche’s Venclexta are cornerstones of treatment, and the approval of CAR T-cell therapies has transformed the treatment armamentarium for diffuse large B-cell lymphoma (DLBCL). The cost of NHL treatment is set to increase with the expected approvals of emerging therapies such as Roche’s glofitamab and ADC Therapeutics’ loncastuximab tesirine(Zynlonta). To control rising costs, payers have a toolbox of utilization management (UM) strategies at their disposal. This report analyzes the reimbursement environment for the major therapies for NHL and chronic lymphocytic leukemia (CLL) in MCOs’ largest fully insured commercial and Medicare plans. In addition, we examine how MCO formulary decisions and UM controls on both the pharmacy and medical benefit affect surveyed hematologist-oncologists’ choice of therapy.
- How do physicians prescribe current NHL / CLL therapies? What restrictions and clinical and nonclinical drivers must they consider, and what is the dynamic interplay between them?
- How do payers view the cost-effectiveness of targeted agents versus traditional chemotherapy-based regimens for CLL? What kind of restrictions do they apply to control use?
- What kind of restrictions do payers apply to NHL and CLL therapies to control their use?
- What are physicians’ views on emerging therapies such as glofitamab and loncastuximab tesirine for DLBCL, as well as the newly approved CAR-T cell therapy Breyanzi (from Bristol Myers Squibb)? How do clinicians expect their prescribing to change, and what factors will drive these changes.
Geography: United States.
Primary research: Survey of 30 U.S. hematologist-oncologists; survey of 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).
Topics: Reimbursement and contracting; access and prescribing; opportunities and challenges for emerging therapies; disease-specific special topic.
Finger Formulary: Formulary coverage data for NHL / CLL therapies by commercial plans covering 163 million lives nationally and Medicare Advantage Part D plans covering up to 16.8 million lives.
Key drugs covered:
Rituxan, Gazyva, Imbruvica, Calquence, Venclexta, Yescarta, Kymriah, Tecartus, Breyanzi, Monjuvi, Polivy, Xpovio.
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.
- Non-Hodgkin's Lymphoma And Chronic Lymphocytic Leukemia - Access & Reimbursement - Detailed, Expanded Analysis (US)
- Access & Reimbursement Non-Hodgkin's Lymphoma and Chronic Lymphocytic Leukemia US July 2021
Author(s): Priyanka Sharma Markanda
Priyanka Sharma, M.B.A., is an analyst on the Oncology team at Clarivate. Prior to joining this company, she was a knowledge management consultant with ZS Associates, where she was responsible for designing and conducting secondary research on disease markets and providing end-to-end support to pharmaceutical clients during products’ life cycles. She also worked at DelveInsight Business Research, where she conducted pharmaceutical market forecasting in multiple therapy areas for various clients. She holds a bachelor’s degree in pharmacy and an M.B.A. in pharmaceutical management from the University Institute of Applied Management Sciences at Panjab University in Chandigarh, India.