Non-Small-Cell Lung Cancer | Access and Reimbursement | US | 2020

The high number of premium-priced non-small-cell lung cancer (NSCLC) therapies and the large number of NSCLC patients have resulted in a significant financial burden for payers. Costs are set to increase with the expected label expansion of currently approved epidermal growth factor receptor(EGFR) and immune checkpoint inhibitors and the continued first-line uptake of AstraZeneca’s Tagrisso and Roche’s Alecensa. To control the rising costs of NSCLC treatment, payers use extensive utilization management strategies. Presenting data from surveys of 31 managed care organizations (MCOs) and 100 oncologists, this access and reimbursement report analyzes the reimbursement environment for 19 of the major therapies for metastatic NSCLC. In addition, it examines how MCO formulary decisions and utilization controls on both the pharmacy benefit and medical benefit affect prescribing by surveyed oncologists.

QUESTIONS ANSWERED

• How do MCOs make formulary inclusion decisions about new NSCLC drugs? What are the pricing and reimbursement drivers and constraints for NSCLC drugs?
• What is the coverage status of the major NSCLC drugs, and what are the key drivers behind their status? What changes do payers plan for the future?
• What utilization management strategies do payers use to control the cost of NSCLC agents? How do they assess the impact of cost and efficacy on the formulary placement of new and existing NSCLC therapies?
• How do physicians prescribe existing NSCLC therapies? What restrictions and clinical and nonclinical drivers must they consider, and what is the dynamic interplay between them?

PRODUCT DESCRIPTION

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.

Market covered: United States.

Primary research:

• Survey of 100 medical oncologists in the United States.
• Survey of 31 U.S. MCO pharmacy and medical directors (PDs/MDs).

Key drugs covered: Opdivo, Keytruda, Tecentriq, Imfinzi, Alimta, Avastin, Abraxane, Cyramza, Alecensa, Xalkori, Zykadia, Alunbrig, Lorbrena, Rozlytrek, Tagrisso, Tarceva, Gilotrif, Iressa, Vizimpro.