Managed Care Strategies in Oncology: US Payer and Prescriber Insights on the Impact of Clinical Pathways, Bundled Payments, and ACOs on Brand Uptake in Colorectal Cancer and Renal Cell Carcinoma | Physician & Payer Forum | US | 2014

Oncology prescribing has changed with the broad adoption of clinical pathways programs, bundled payment arrangements, and accountable care organizations (ACOs). Each of these managed care reforms is designed to promote cost-effective and evidence-based prescribing while working to lower costs of care, but each mechanism works differently to benefit or hamper specific oncology brands.

This report explores how these three managed care forces are reshaping the competitive pharmaceutical landscape for drugs treating colorectal cancer (CRC) and renal cell carcinoma (RCC) in different ways.

The landscape of agents for the treatment of CRC and RCC is changing, owing to the 2013 approval of capecitabine, the generic version of Roche’s oral Xeloda. The introduction of the generic version may attract oncologists to try it as single-agent therapy in stage III and IV CRC, potentially supplanting chemotherapy and chemotherapy with targeted agents (a crowded field including FOLFOX, CAPOX, and 5-FU/leucovorin in stage III, and Roche/Chugai’s Avastin (bevacisumab), Bristol-Myers Squibb/Eli Lilly/Merck/Serono’s Erbitux (cetuximab), Regeneron/Sanofi’s Zaltrap (ziv-aflibercept), and Amgen/Takeda’s Vectibix (panitumumab) in stage IV). The CRC market is poised for further change with the forecast 2016 launch of OncoVax, an immunotherapy for use as first-line therapy after surgery in stage II. To the extent that this agent succeeds in preventing recurrence, it will inhibit sales of all other agents for CRC.

In the RCC and CRC markets, prescribers’ choice of therapy and payers’ decisions about formulary inclusion and pathway placement will become increasingly complex as developers strive to differentiate new entrants within the evolving treatment algorithms and to position themselves as favorably as possible on payers’ formularies and on pathways.

In this report, we surveyed 100 oncologists and 40 managed care organization (MCO) pharmacy and medical directors to assess their attitudes, expectations, and reservations regarding pathways, bundled payment arrangements, and ACOs. We then pressed for detailed responses about how these managed care reforms are likely to influence access to, and prescribing of, specific agents.