Chimeric Antigen Receptor (CAR) T-Cell Therapy – Access & Reimbursement – Access & Reimbursement – Chimeric Antigen Receptor (CAR) T-Cell Therapy (US)
Ever since Novartis’s Kymriah became the first chimeric antigen receptor (CAR) T-cell therapy approved by the FDA for a cancer indication (acute lymphoblastic leukemia) in 2017, this class of drugs has become a key component of treatment of hematological malignancies. Therapies such as Gilead / Kite Pharma’s Yescarta and Johnson & Johnson Innovative Medicine’s Carvykti offer hope to patients with relapsed/refractory (R/R) non-Hodgkin’s lymphoma (NHL) and patients with R/R multiple myeloma. However, CAR T-cell therapies’ list prices—some exceeding $400,000 per infusion—create budgetary concerns for payers that may affect treatment decisions. As the market landscape for these novel therapies continues to evolve, we explore how MCO PDs/MDs approach reimbursement of these expensive therapies for NHL and multiple myeloma and the impact on hematologist-oncologists’ prescribing.
Questions answered
- What factors influence hematologist-oncologists’ choice of a CAR T-cell therapy in second and later lines of treatment?
- How do commercial and Medicare Advantage plans reimburse CAR T-cell therapies, and what kind of contracts and payment schemes do MCOs commonly use or hope to use to address these therapies’ high cost?
- What prior authorization requirements and other utilization management controls do payers apply to CAR T-cell therapies, and how do these restrictions affect hematologist-oncologists’ prescribing?
- How are payers and physicians incorporating other drug classes, particularly bispecific antibodies, into NHL and myeloma treatment? Are payers favoring these lower-cost treatments prior to a CAR T-cell therapy?
Primary research: survey of 100 U.S. hematologist-oncologists, survey of 30 U.S. managed care organization pharmacy and medical directors
Fingertip Formulary: Formulary coverage by commercial plans covering more than 165 million lives nationally
Real-world data: U.S. pharmacy and medical claims data
Key drugs covered: Abecma, Breyanzi, Carvykti, Kymriah, Tecartus, and Yescarta
Product description
Leveraging Clarivate’s proprietary data sources and surveys with physicians and payers, Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of payer policy on physician prescribing behavior in the United States. Through detailed analyses of drug coverage, restriction policies, and contracting, as well as payer and prescriber perspectives on key marketed drugs and their receptivity to emerging therapies, this report enables you to:
- Identify and learn how to overcome roadblocks to market access to best position your brand.
- Identify key stakeholders and reimbursement drivers and assess the impact that reimbursement decisions have on treatment selection.
- Evaluate competitor strategies for securing favorable market access terms.
