Hematological Malignancies | Access and Reimbursement | US | 2017

The chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML) markets are becoming increasingly crowded, with recent marketing authorizations expanding therapy options for patients. As more therapies are added to the armamentarium for these indications, spiraling healthcare costs mean payers must make increasingly economical reimbursement decisions. In addition, oncologists are faced with increasing challenges because they must balance superior efficacy with the rising cost for patients.

Questions answered:

• Reimbursement of CML and CLL therapies depends on both clinical and cost-related factors. What is the single most influential factor for formulary placement of CML and CLL therapies? How widespread is the use of pharmacoeconomic models for measuring the cost and efficacy impact of CML and CLL therapies and which cost- effectiveness models do payers favor? How much of an impact do payer strategies have on prescribing of key current CML and CLL therapies?
• Generic versions of Gleevec have been available for over a year. How does the coverage status of Gleevec brand differ from that of imatinib generics? How aware are the MCO directors of existing copay assistance programs for both generic imatinib and branded Gleevec and what impact do copay programs have on formulary inclusion decisions?
• Acalabrutinib and ublituximab are emerging CLL therapies that are expected to become available in the US in the next two years. What are the most important attributes that payers and prescribers believe the pharmaceutical companies should focus on when developing new CML and CLL therapies? How will the pricing of emerging therapies impact their tier placement? If both acalabrutinib and ublituximab were both to be placed on a preferred tier, would patient shares of Venclexta and Imbruvica suffer?

Scope:

• Markets covered: United States
• Methodology: Surveys of 100 hematologist-oncologists and 30 managed care company officials, including 15 pharmacy directors and 15 medical directors, in March 2017
• Indication coverage: chronic lymphocytic leukemia and chronic myeloid leukemia
•  Key drugs covered: Rituxan, Zydelig, Arzerra, Imbruvica, Gazyva, Venclexta, Gleevec, Sprycel, Tasigna, Bosulif, Iclusig, Synribo
•  Key companies mentioned: Roche/Genentech, Novartis