Breast Cancer | Access and Reimbursement | US | 2018


As one of the largest therapy markets in oncology, driven by a high incidence and long treatment durations, the treatment of metastatic HR+/HER2– breast cancer remains commercially lucrative for drug developers. Premium-priced established drugs—Pfizer’s Ibrance and Novartis’s Afinitor—face competition from newly launched agents—Novartis’s Kisqali, Eli Lilly’s Verzenio, and AstraZeneca’s Lynparza—as well as three new oral therapies launching by 2020. Facing escalating drug costs and tightening healthcare budgets, surveyed U.S. payers indicated that new drugs will face reimbursement challenges if they do not prove cost-effectiveor offer efficacy/safety superior tothat of existing therapies. Understanding the market access drivers that are most important to payers and oncologists is essential to maximizing a drug’s market uptake.

Questions answered:

  • What are the most commonly prescribed drugs for HR+/HER2– breast cancer, and how have Kisqali and Verzenio been adopted into physician prescribing patterns? How much influence do payer-imposed restrictions and cost-sharing have over oncologists’ choice of therapy?
  • How has Ibrance faired against the newer CDK4/6 inhibitors in terms of MCO formulary coverage, and what kinds of contracting agreements are in place for branded agents? What are the common ranges of contracted rebates?
  • What clinical and economic attributes most influence MCOs’ formulary placement decisions, and how does pharmacoeconomic and real-world data factor into coverage?
  • What are oncologists’ assessments of late-stage therapies for HR+/HER2– breast cancer (alpelisib, taselisib, and entinostat), and how will these drugs affect future patient share of all therapies? Which MCO cost-control strategies would most restrict oncologists’ prescribing of these new therapies?

Product Description

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

Markets covered: United States

Primary research:

  • Survey of 101 medical oncologists in the United States.
  • Survey of 32 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).

Key companies: AstraZeneca, Eli Lilly, Novartis, Pfizer, Roche, Syndax Pharmaceuticals

Key drugs: Ibrance, Afinitor, Kisqali, Verzenio, Lynparza, Faslodex, Letrozole, Anastrozole, Exemestane

Content highlights:

  • Reimbursement and contracting.
  • Access and prescribing.
  • Special topics.
  • Opportunities and challenges for emerging therapies.
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