Biomarkers in Oncology – Access & Reimbursement – Access & Reimbursement – Biomarkers in Oncology – Biomarker-Driven Prescribing in Breast Cancer, Ovarian Cancer, and Prostate Cancer (US)

Biomarker-driven prescribing is paramount in key oncology indications, particularly breast cancer, ovarian cancer, and prostate cancer. Key to all three indications are PARP inhibitors, such as AstraZeneca’s Lynparza, GlaxoSmithKline’s Zejula, Clovis Oncology’s Rubraca, and Pfizer’s Talzenna. Although biomarker-driven therapies offer the advantage of selecting the patients most likely to respond to targeted therapy, they are typically 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 to a successful market strategy.

Questions answered

• What factors most influence payers’ reimbursement decisions about biomarker-driven therapies in breast cancer, ovarian cancer, and prostate cancer?
• Do access and reimbursement challenges differ by indication, and how well established are biomarkers in each indication?
• Which payer-imposed utilization management controls most restrict oncologists’ prescribing of biomarker-driven therapies?
• What are payers’ opinion of emerging agents, and how will oncologists’ prescribing patterns change with the launch of new therapies?
• What factors influence reimbursement and access to companion biomarker tests?

Geography: United States

Primary research: Survey of 100 U.S. medical oncologists; survey of 30 U.S. managed care organization pharmacy and medical directors

Fingertip formulary: Formulary coverage by commercial plans covering more than 169 million lives nationally

Real-world data: U.S. pharmacy claims data

Key drugs covered: Lynparza, Zejula, Elahere, Akeega, Talzenna, Enhertu, Orserdu, Piqray, and Rubraca

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.

Solution enhancement

Access & Reimbursement includes key analyses from Clarivate Real-World Data Product—comprehensive and timely data that provide clarity around the healthcare experiences and activities of hundreds of millions of patients, HCPs, and payers. Analyses include payer mix, percentage of claim rejections for key therapies, and reasons for claim rejection.