Zitter Pulse Check: Breast Cancer


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.

Market Activity

In 2019, Herceptin (trastuzumab) from Genentech USA, Inc., a Roche Group unit, faced multiple biosimilar competitors for the first time. P&T members from commercial payers with almost half of covered lives said they were significantly or more likely than unlikely to prefer biosimilar Herceptin over other HER2-positive adjuvant therapies (see chart below). In addition, respondents from payers with the majority of covered lives said it was not at all likely or more unlikely than likely that they would not cover biosimilar Herceptin.

Payers covering more than half of commercial lives said that only two biosimilars on the market were needed to negotiate contracts with those products. The commercial payer respondents said the average discount, inclusive of rebates, required for them to prefer biosimilar Herceptin over other HER2-positive adjuvant therapies is 35%. Among P&T members who work for Medicare plans, the average percentage was 32%.

SURVEYS WERE COLLECTED 2/27/2019 – 4/11/2019

Key Findings


Among P&T members from commercial and Medicare payers who said they were likely to engage in preferential utilization contracts for the CDK4/6 inhibitors, the top strategy by covered lives was market share-based contracts. Dose-guarantee contracts were not favored by many respondents. One commercial respondent said it anticipated seeking an access-based contract by which the “product will have parity access to other products based on [its] approved indication.”

Clinical Pathways

Commercial payers with one-third of covered lives said they developed their clinical treatment pathways internally with input from multiple external sources, which was the leading strategy. The next most common approach was internally developing pathways with no input from listed organizations. Respondents also used pathways from sources such as Via Oncology (now known as ClinicalPath), AIM Specialty Health and eviCore.

Payer Management

In late 2018, the FDA approved Pfizer Inc.’s Talzenna (talazoparib), which joined AstraZeneca’s Lynparza (olaparib) as the only PARP inhibitors approved to treat deleterious or suspected deleterious germline BRCA-mutated, HER2-negative metastatic breast cancer. Commercial payers with more than half of covered lives said they would cover Talzenna at parity with Lynparza for this indication (see chart at right). Payers with almost 40% of commercial lives were unlikely to prefer Talzenna over Lynparza.

SURVEYS WERE COLLECTED 2/27/2019 – 4/11/2019


Contracting Opportunities

Message: “We are very open to being flexible with payers, and will entertain many contracting scenarios. Obviously, with three oncology biosimilars (Avastin, Herceptin, Rituxan), we will offer packaged deals together, but payers certainly do not have to take this approach.”

Payer Thoughts: “Although the industry is not always a fan of this packaged approach, it may make sense in this case.”

Oncology Biosimilars Could Prompt Preferencing

So far, biosimilar uptake has been relatively slow in the U.S. since the 2015 launch of Sandoz Inc.’s Zarxio (filgrastim-sndz), the first product to use the 351(k) approval pathway. But recent and pending launches have resulted in therapeutic classes with more than one biosimilar, which may be the push that payers need to begin preferring them over their reference products and, in turn, realizing savings in some costly therapeutic classes.

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

Magellan Rx Starts Oncology Biosimilars Program

In June 2019, Magellan Rx Management, the PBM division of Magellan Health, Inc., announced its launch of an oncology biosimilars program, preparing its health plan customers for the expected market entry of biosimilars for three cancer-fighting drugs — Herceptin, Rituxan and Avastin — later in the year. The three drugs together account for $9 billion in U.S. drug sales and almost $50 million in annual drug spend per 1 million covered commercial lives, says Magellan Rx.

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

© 2024 MMIT
AIS Health Staff

AIS Health Staff

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