A Survey of Oncologists and MCO Pharmacy and Medical Directors

Targeted small-molecule agents have emerged as key treatment options for biomarker-defined non-small-cell lung cancer (NSCLC) patient populations, namely EGFR-mutation-positive and ALK-translocation-positive, advanced/metastatic patients. Roche/Genentech/Astellas’s Tarceva (erlotinib) and Pfizer’s Xalkori (crizotinib) are entrenched in the treatment of first-line patients. Several EGFR and ALK inhibitors are in various stages of development, the most advanced of which are poised to initially gain approval for refractory patients, including AstraZeneca’s AZD-9291, similar to Novartis’s Zykadia (ceritinib), approved for the treatment of Xalkori-treated patients.

Targeted small-molecule agents will continue to have a central role in the treatment of NSCLC, not only in the first- but also in the subsequent-line settings, with the sequential administration of EGFR and ALK inhibitors expected to become standard practice. The uptake of novel therapies will be dependent on pricing and reimbursement decisions, as well as uptake, pricing, and reimbursement of companion diagnostic tests aiming to identify those patients most likely to benefit from treatment. Tissue availability for testing is a significant hurdle to test NSCLC patients, but new methodologies such as blood-based testing could lead to a greater percentage of patients being tested and treated with a targeted, biomarker-driven small-molecule agent.

Questions Answered in This Report:

  • Understand the current and future role of targeted small-molecule agents in the treatment of NSCLC. For what treatment settings/lines of therapy do physicians prescribe them? What factors influence prescribing of these agents over other available therapies? How will emerging small-molecule targeted therapies fit into the treatment algorithm? In what tier will MCO PDs/MDs likely place them?

  • Biomarker testing has, and will continue to have, a central role in the diagnosis and treatment of NSCLC. What are the main barriers to testing? What percentage of patients receives definitive results from biomarker tests? How are biomarker tests reimbursed? What is the average time taken to receive biomarker test results?

  • Explore payer attitudes towards novel targeted small-molecule agents for NSCLC. What factors will most influence formulary inclusion of novel targeted small-molecule agents? What will their tier placement be? What is the average out-of-pocket cost for targeted small-molecule agents? What does the tiering mean for uptake of emerging therapies?


This U.S. Physician & Payer Forum report contains insights from a survey of 101 medical oncologists and 30 managed care organization (MCO) pharmacy/medical directors (PD/MDs) to capture their views on anticipated prescribing and reimbursement barriers in relation to current and emerging targeted small-molecule agents in NSCLC.

Markets covered: United States.

Primary research: Online survey of 101 oncologists and 30 MCO PD/MDs.

Author(s): Orestis Mavroudis-Chocholis Ph.D.