Breast Cancer | Access & Reimbursement | US | 2016

Owing to the large size of the advanced/metastatic, HR-positive/HER2-negative breast cancer market, as well as the long durations of treatment typically associated with treating these patients, this subpopulation is of high commercial interest to drug developers. Two premium-priced targeted therapies have received FDA approval specifically for this population; Ibrance (Pfizer’s palbociclib), a CDK4/6 inhibitor, and Afinitor (Novartis’s everolimus), an mTOR inhibitor, are both first-in-class agents in this market and represent the beginning of a new wave of targeted therapies being investigated in combination with hormonal therapy for the treatment of this disease. Both current and emerging premium-priced therapies in this market segment face the challenge of wresting market share from heavily genericized and less-expensive hormonal agents, which represent a standard of care. In the context of escalating drug costs within the HR-positive/HER2-negative breast cancer population, devising a smart pricing strategy for novel therapies will be crucial to ensure market access, secure reimbursement, maximize uptake, and realize commercial potential.

Questions Answered:

• Currently available treatments for hormone-receptor-positive/HER2-negative (HR+/HER2-) breast cancer include both highly genericized and premium-priced agents. What factors most strongly influence and constrain surveyed physicians’ prescribing of current therapies used for the treatment of HR-positive/HER2-negative breast cancer?
• Several novel agents are in late-phase development for HR+/HER2- breast cancer. What are surveyed oncologists’ views on emerging CDK4/6 inhibitors and PI3K inhibitors in late-phase development? How do surveyed oncologists anticipate using these therapies? How do surveyed physicians expect prescribing of hormone therapies, chemotherapies, and targeted therapies currently used for the treatment of HR+/HER2- breast cancer to change in the future, and what factors, if any, will drive these changes?
• The rising costs of new breast cancer therapies are a growing concern for payers. What is the current commercial managed care organization (MCO) coverage of therapies used to treat HR-positive/HER2-negative breast cancer? How will it change in the future? What factors have the most influence on surveyed payers’ formulation decisions for breast cancer therapies? Which restrictions are most commonly used in commercial plans for breast cancer therapies?

Scope: 

This report, titled The Escalating Cost of Treating HR-Positive/HER2-Negative Breast Cancer: U.S. Physician and Payer Perception of Premium-Priced Prescribing, captures surveyed medical oncologists’ and payers’ views on anticipated prescribing and reimbursement barriers for current and emerging therapies for HR+/HER2- breast cancer.

Markets covered: United States.

Primary research: Online survey with 100 medical oncologists and 30 MCO PDs/MDs.

Emerging therapies: Phase III: 4 drugs.