CAR T-cell therapies, such as Gilead / Kite Pharma’s Yescarta and Janssen’s Carvykti, have given new hope to patients with relapsed/refractory (R/R) non-Hodgkin’s lymphoma (NHL) and patients with R/R multiple myeloma. Priced at more than $400,000 per infusion, these therapies also come with unique administrative and budgetary challenges for managed care organizations (MCOs) and providers. As the market for these novel therapies grows, we explore how MCO pharmacy directors and medical directors (PDs/MDs) approach reimbursement of these expensive therapies for NHL and multiple myeloma and how coverage decisions in their largest commercial and Medicare Advantage plans impact prescribing among surveyed hematologist-oncologists.
Geography: United States.
Primary research: Survey of 100 U.S. hematologist-oncologists; survey of 40 U.S. managed care organization (MCO) pharmacy and medical directors (PDs / MDs).
Key drugs covered: Breyanzi, Kymriah, Tecartus. Yescarta, Abecma, Carvykti
Key analysis provided:
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, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.