Is There a Disconnect Between Physician and Payer Perceptions of Therapies Across Key Indications?

The treatment of both solid and hematological cancers is associated with a wide range of serious side effects, including febrile neutropenia, anemia, nausea and vomiting, and oral mucositis. In addition to being life threatening, these side effects have significant detrimental impact on patients’ quality of life and often require dose delays, dose reductions, or cessation of cancer treatment, thereby compromising outcomes. As a result, the optimal treatment of chemotherapy-related side effects using supportive care therapies is an integral part of good cancer patient care. Recently approved biosimilar filgrastim (Sandoz’s Zarxio), the first biosimilar to receive FDA approval, will drive down price, assuming that both payers and physicians are receptive to biosimilar therapies. Anemia associated with both cancer and its treatment has a huge impact on patients, but some physicians remain reluctant to prescribe erythropoiesis-stimulating agents (ESAs), because of their toxicity profile and negative effect on outcomes.

Preventative treatment of chemotherapy-induced nausea and vomiting has become a routine component of treatment for specific chemotherapy regimens; however, many patients still suffer symptoms, and agents have been costly. The arrival of generic drugs and innovative formulations should improve access and symptom control for patients if payers facilitate access to these therapies. Management of oral mucositis, especially for patients with squamous cell cancer of the head and neck undergoing radiotherapy/chemoradiotherapy, is inadequate and leaves patients with terrible symptoms and poor quality of life. Despite suboptimal treatments, access to current therapies is variable and comes with substantial patient out-of-pocket costs. Across these diverse supportive care indications run the themes of patient access, increasing costs, and restrictive measures.

Questions Answered in This Report:

  • What are the current drivers and barriers to prescribing granulocyte-macrophage colony-stimulating factors (G(M)-CSFs) for the prevention and treatment of febrile neutropenia in patients receiving chemotherapy? What are the main cost-related and clinical constraints to the prescribing of G(M)-CSFs? What factors influence the selection of agents?

  • What factors do payers consider when covering G(M)-CSFs on formulary? Which agents most frequently gain preferred status? What impact will the imminent arrival of biosimilar filgrastim have on pricing and reimbursement dynamics in this drug class?

  • What are the key drivers and limiters that surveyed oncologists highlight when selecting treatment for anemia associated with cancer and its treatment? What cost-control measures do prescribers face when prescribing ESAs? What are oncologists’ perceptions of and prescribing intentions for biosimilar epoetin alfa?

  • What attributes do oncologists use to select therapies to manage chemotherapy-induced nausea and vomiting in the acute and delayed setting? What are physician and payer perceptions of recently launched combination (NK1/5HT3RA) drugs? What measures do payers employ to contain costs?

  • What are physician perceptions of newly launched Varubi (rolapitant)? To what degree will physicians prescribe the new therapy on availability of generic aprepitant? On which tier will payers position Varubi at different price points?

  • What do surveyed oncologists and payers consider the area of highest unmet need in oncology supportive care? What clinical comparator do payers expect for an emerging therapy for oral mucositis or chemotherapy-induced nausea and vomiting?


Decision Resources Group’s U.S. Physician & Payer Forum report Supportive Care in Oncology: Is There a Disconnect Between Physician and Payer Perceptions of Therapies Across Key Indications? explores the evolving reimbursement and market access landscape for oncology supportive care therapies for the treatment of febrile neutropenia associated with chemotherapy, anemia associated with cancer and its treatment, chemotherapy-induced nausea and vomiting, and oral mucositis. The dynamics affecting prescribing of key supportive care drugs in an increasingly cost-conscious climate are uncovered, and the challenges facing widely used therapies in the face of the first biosimilars to enter the U.S. market are explored, as well as the impact of generic entries on established brands and the barriers that emerging therapies face when aspiring to penetrate supportive care markets.

Markets covered: United States.

Primary research: Online survey of 51 medical oncologists, 50 hematological oncologists, 30 managed care organization pharmacy directors/medical directors.

Author(s): Andrew Merron, Ph.D.

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