Biomarkers in Oncology | Access & Reimbursement | US | Non-Small-Cell Lung Cancer, Breast Cancer, and Colorectal Cancer | 2023

Biomarker-driven prescribing is paramount in key oncology indications. The use of biomarkers is entrenched in non-small-cell lung cancer (NSCLC), breast cancer, and colorectal cancer. Biomarker-associated therapies, such as Merck & Co.’s Keytruda and Bristol Myers Squibb’s Opdivo, cater to both large and niche patient subpopulations within these common oncology indications. Although these therapies offer the advantage of selecting the patients who are most likely to respond to targeted therapy, typically they are premium-priced and subject to payer restrictions and cost-containment strategies. Identifying the barriers that influence the coverage and uptake of biomarker-driven therapies is key for a successful market strategy.

QUESTIONS ANSWERED

• What clinical and nonclinical factors most influence payers’ reimbursement decisions about biomarker-driven therapies in NSCLC, breast cancer, and colorectal cancer?
• What utilization management controls do oncologists commonly encounter on biomarker-driven therapies and which prior authorization criteria most restrict their prescribing?
• What are payers’ opinions about emerging agents, and how will oncologists’ prescribing patterns change with the launch of new therapies?
• What are oncologists’ biomarker testing rates for the studied cancers and what percentage of surveyed MCOs reimburse the cost of the tests?

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. Each report includes up-to-date analyses of drug coverage and restriction policies as well as payer and prescriber perspectives on key marketed drugs and their receptivity to emerging therapies.

Markets covered: United States

Key drugs: Keytruda, Opdivo, Yervoy, Enhertu, Kadcyla, Perjeta, Erbitux, Tukysa, Vectibix, Verzenio, Imfinzi, Imjudo, Margenza, Orserdu, Trodelvy, and Braftovi.