Zitter Pulse Check: Breast Cancer (June 2022)

Coverage

Breast cancer is a high-cost category with an increasing number of therapies, including biosimilars, that treat different subtypes of the condition. To help stakeholders absorb datapoints and perceptions from all directions and synthesize those insights into a tangible strategy for breast cancer, Zitter Insights surveys a leading panel of pharmacy and therapeutics (P&T) decision makers at payers and integrated delivery networks. The Managed Care Oncology Index combines deep payer insights with the industry standard in market access information to produce quarterly reports and insights summaries on leading oncology brands.

Payer Management

Commercial payers with more than two-thirds of covered lives said their organization manages breast cancer agents to label, and those with about one-tenth of lives manage the therapies more restrictively than the approved label. Within 12 months of the survey period, payers with more than two-thirds of covered lives said they expect to manage breast cancer drugs to their FDA-approved label, while those with more than one-tenth of lives expect they will be more restrictive than the label.

Payers with almost half of commercial lives said that an approved prior authorization for a breast cancer therapy lasts 10 to 12 months after a prescription’s first fill, while those more than one-quarter of lives said it persists longer than 12 months (see chart).

pulse-check-breast-cancer-frequency-of-approved-pa
SURVEYS WERE COLLECTED 3/4/22-4/19/22

Key Findings

CDK 4/6 Inhibitors

Among the cyclin-dependent kinase (CDK) 4/6 inhibitors for pre-menopausal women with hormone receptor-positive (HR+), human epidermal growth factor receptor-negative (HER2-) metastatic breast cancer, Medicare lives are more likely than commercial lives to be covered under preferential utilization contracts for first-line use of Pfizer Inc.’s Ibrance (palbociclib) and Novartis Pharmaceuticals Corp.’s Kisqali (ribociclib). Those two drugs, as well as Eli Lilly and Co.’s Verzenio (abemaciclib), also were covered more for second-line use in payers covering Medicare lives. For post-menopausal women, Medicare payers mostly engage in preferential utilization contracts for first-line use of Kisqali, while commercial payers favor Ibrance. For second-line treatment, commercial and Medicare lives were more likely to be covered under such contracts for Ibrance.

Prescribing Practices

Among oncologists, Herceptin (trastuzumab) from Genentech USA, Inc., a member of the Roche Group, was the breast cancer agent prescribed most often over the 12 months prior to the survey. Also frequently prescribed were Arimidex (anastrozole) from ANI Pharmaceuticals, Inc. and Bristol Myers Squibb’s Taxol (paclitaxel). Almost three-fourths of oncologists said they consider National Comprehensive Cancer Network (NCCN) guidelines strongly influential on their prescribing actions for breast cancer, and more than a quarter said they were moderately influential. Many of the respondents noted that the guidelines are considered the standard of care.

Herceptin Biosimilars

Herceptin is a targeted therapy for patients with HER2-positive (HER2+) breast cancer. The drug can also be used to treat patients with metastatic HER2+ gastric or gastroesophageal junction adenocarcinoma. The FDA initially approved the drug in September 1998. Since July 2019, five Herceptin biosimilars have launched in the U.S. Payers are most likely to manage all of those biosimilars at parity with branded Herceptin except Amgen Inc.’s Kanjinti (trastuzumab-anns), which is most likely to be preferred over Herceptin (see chart). That drug was the first biosimilar to hit the U.S. market, launching July 18, 2019. Almost half of oncologists said that Kanjinti was the Herceptin biosimilar they were most likely to prescribe over some other HER2+ adjuvant therapies in the 12 months following the survey period. Approximately two-fifths of respondents said they were likely to take the same action for the other four biosimilars.

pulse-check-breast-cancer-payer-management-for-herceptin-biosimilars
SURVEYS WERE COLLECTED 3/4/22-4/19/22

Trends

Antibody-Drug Conjugates

Message: “The message was that the ADC technology is an innovative approach to deliver monoclonal antibodies for a variety of cancers. The technology is being used in a variety of clinical trials including partnerships with other manufacturers. The technology is already on the market and is included in the FDA-approved product Enhertu.”

Payer Thoughts: “The discussion and message around the ADC technology was interesting. It seems like an innovative approach that has the flexibility to be effective in a variety of therapeutic areas. While most of the products that use it are not approved yet, it will definitely be considered in the review once those products are approved.”

Third-Party Care Pathways Gain Steam as Cancer Costs Rise

With the costs of treating cancer patients rising ever higher, payers and providers are increasingly turning to third-party pathways — or treatment protocols designed to provide the optimal therapy regimens — to improve outcomes and reduce excess costs in a variety of conditions, including breast cancer. But not all pathways are created equal, and it’s crucial for oncology drug manufacturers to understand their nuances if they want to ensure their therapies are able to reach the most patients.

Subscribers to AIS’s RADAR on Drug Benefits may read the in-depth article online

MedPAC Suggests Biosimilars Are Helping Bring Down ASPs

While total Medicare spending on all Part B drugs continued to rise from 2018 to 2019, a Medicare Payment Advisory Commission (MedPAC) report found that average sales prices (ASPs) for some traditionally costly drugs actually decreased, a trend that may be due to biosimilar competition, posits the report.

Subscribers to AIS’s RADAR on Specialty Pharmacy may read the in-depth article online

0 Comments
AIS Health Staff

AIS Health Staff

Related Posts

mother-holding-asthma-inhaler-for-daughter-struggling-to-breath
September 15

Zitter Pulse Check: Severe Asthma (September 2022)

Read More
doctor-taking-blood-sample
September 1

Zitter Pulse Check: Diabetes (August 2022)

Read More
young-women-hand-scratch-the-itch-on-the-arm-healthcare-and-medicine
August 25

Zitter Pulse Check: Atopic Dermatitis (August 2022)

Read More

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today