Breast Cancer | Access and Reimbursement |The influence of value assessment models on clinical pathways | US | 2017

Facing a dramatic rise in expenditures for cancer therapies, U.S. healthcare payers are increasingly assessing the value of drugs relative to their prices, taking into account attributes such as survival, disease burden, toxicity, patient preference, and impact on overall healthcare costs. Treatment of advanced, metastasized breast cancer has challenged payers because of the complexity and high cost of regimens, such as Genentech’s Perjeta/Herceptin in combination with docetaxel as a first-line treatment for metastatic HER2+ breast cancer. Several value assessment models have emerged to help managed care organizations (MCOs) determine the value, including the cost-effectiveness, of therapies. As payment reform intensifies, understanding the effect of value assessment on MCOs’ reimbursement decisions is critical to a sound market access strategy for drugs launching for breast cancer and other diseases.

Questions answered

  • How common is MCOs’ application of value assessment in determining coverage of breast cancer drugs on commercial plan formularies?
  • Which value assessment models will MCOs likely use to evaluate new breast cancer therapies, and what will be the likely effect on coverage policies and, ultimately, on oncologists’ prescribing decisions?
  • What attributes of a breast cancer drug do payers and oncologists value most highly?
  • What role do value assessments play in pay-for-value initiatives such as outcomes-based contracting and indication-specific pricing?
  • How do payers view cost-effectiveness metrics for specific breast cancer populations versus oncology as a whole and other therapy areas?


Access & Reimbursement: Provides in-depth insight regarding the impact of payer policy on physician prescribing behavior so that companies can build a market access strategy and optimize their brand positioning.

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