BURLINGTON, Mass., Oct. 5, 2016 /PRNewswire/ -- Decision Resources Group finds that biomarker-targeted therapies with companion diagnostic tests are viewed positively by both oncologists and payers in the United States and EU5. Drawing on insights from surveyed U.S. medical oncologists and medical and pharmacy directors of managed care organizations, as well as surveyed European medical oncologists and interviewed EU5 payers, our findings reveal however that it is becoming increasingly challenging for new biomarker-targeted cancer therapies to secure favorable formulary placement, in the increasingly price-sensitive oncology market. Interviewed payers in the EU5 in particular highlight that biomarker-targeted cancer therapies may face growing market access challenges, as heath authorities continue to tighten controls on pricing and reimbursement in response to increasing pressure to curb pharmaceutical expenditure.
Other key findings from the Access & Reimbursement (US and EU5) contents entitled "Realizing the Potential of Personalized Medicine in Oncology: Biomarker-Driven Prescribing in Breast Cancer, Non-Small Cell Lung Cancer, and Ovarian Cancer", and the "EU5 Market Access Status for Personalized Medicines in Oncology: Biomarker-Driven Prescribing in Non-Small Cell Lung Cancer, Malignant Melanoma, and Ovarian Cancer" include:
- A proportion of surveyed U.S. and EU5 medical oncologists indicate that, given the choice, they would prefer to prescribe a PD-1/PD-L1 inhibitor that is not restricted by PD-L1 status to their metastatic NSCLC patients. Opdivo may, therefore, have an edge over Keytruda for some physicians given that its label for previously treated metastatic NSCLC is not tied to a biomarker test.
- Interviewed payers report that biomarker testing costs are usually funded by the health care systems in the EU5. European payers however would prefer that testing be included in the overall cost associated with drug treatment and be factored into P&R negotiations with drug companies. In the U.S. biomarker testing is usually paid by the MCOs and/or the hospital/clinic, however in many cases the patient has to pay for testing out-of-pocket.
- Premium pricing for novel, second- and third-generation PARP inhibitors could lead to more-stringent prescribing restrictions in the United States and Europe and, as a result, deter oncologists from prescribing these drugs. Negotiated discounts or rebates may be key to maximizing uptake of PARP inhibitors in ovarian cancer.
- Among novel biomarker-targeted cancer therapies, surveyed U.S. and EU5 medical oncologists expect clinical efficacy to drive their choice of treatment; however, U.S. and EU5 payers are likely to base reimbursement decisions on the comparative overall cost of treatment.
Comments from Decision Resources Group Analyst Izabela Ammermann, Ph.D.:
- "The majority of oncologists and payers across the EU5 look positively at biomarker-targeted therapies; however, uptake of these therapies could be increased even further by increasing the percentage of patients tested for the presence of biomarker, such as BRCA1/2 mutations in ovarian cancer, and this can be achieved by streamlining biomarker testing systems."
- "Manufacturers should provide a competitive price to secure favorable formulary status of their biomarker-targeted therapies. Payers are highly sensitive to drug acquisition costs and the overall cost of an expensive agent to their plans, relegating higher-priced agents to less-favorable tiers."
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Decision Resources Group offers best-in-class, high-value data, analytics and insights products and services to the healthcare industry, delivered by more than 900 employees across 14 global locations. DRG provides the pharmaceutical, biotech, medical device, financial services and payer industries with the tools, insights and advice they need to compete and thrive in an increasingly complex and value-based marketplace. DecisionResourcesGroup.com.
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SOURCE Decision Resources Group