Melanoma is a high-cost category with an increasing number of therapies that treat the condition. To help stakeholders absorb datapoints and perceptions from all directions and synthesize those insights into a tangible strategy for melanoma, 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.
Combination therapies often are used to treat melanoma. Commercial payers with about one-third of covered lives said they anticipate taking measures to control the use of these regimens. The top actions include requiring prior authorizations for the individual drugs and stricter enforcement of prior authorizations. Payers with one-quarter of lives will prefer monotherapies over combination therapies.
For payers that anticipate controlling combination therapy use, the most influential factor on their coverage decisions for these regimens is cost, followed by minimal adverse events (see chart). Payers managing more than 90% of lives said that they would cover members trying monotherapy first, saying that it is a more cost-effective option.
Tecentriq + Cotellic + Zelboraf
On July 30, 2020, the FDA approved Roche Group subsidiary Genentech USA, Inc.’s Tecentriq (atezolizumab) plus Cotellic (cobimetinib) and Zelboraf (vemurafenib) for the treatment of people with BRAF V600 mutation-positive advanced melanoma. Payers covering almost three-quarters of lives said they would cover the regimen at parity with all other combination therapies. More than two-thirds of oncologists said they would prescribe the regimen.
Bristol Myers Squibb’s Opdivo (nivolumab) was the drug prescribed most often in the 12 months prior to the survey, with more than four-fifths of oncologists writing a script for it. Also commonly prescribed were Yervoy (ipilimumab), also from Bristol Myers Squibb, and Merck & Co., Inc.’s Keytruda (pembrolizumab), with approximately three-quarters of oncologists prescribing them. Least prescribed was Imlygic (talimogene laherparepvec) from Amgen Inc. subsidiary BioVex, Inc.
Oncologists ranked Opdivo as their most ideal firstline therapy, cited by about one-third of respondents (see chart). Keytruda was selected by about one-fifth of respondents. Both drugs were chosen due to their efficacy. Oncologists also said that Opdivo was their No. 1 second-line therapy, followed closely by Keytruda, Yervoy and Novartis Pharmaceuticals Corp.’s Mekinist (trametinib).
Message: “There was a presentation on the cost-effectiveness of the Opdivo/Yervoy combination. This presentation mostly centered on the cost of the combo and a quality adjusted life year. There were comparisons to the single regimen Opdivo and Yervoy.”
Payer Thoughts: “These messages are interesting. I would like to see how these numbers compare to competitors (Keytruda), not necessarily to the individual drugs within the combo products.”
FDA Approves Melanoma Combination Therapy
On July 30, 2020, the FDA approved Roche Group subsidiary Genentech USA, Inc.’s Tecentriq (atezolizumab) plus Cotellic (cobimetinib) and Zelboraf (vemurafenib) for the treatment of people with BRAF V600 mutation-positive advanced melanoma. The agency gave it priority review, which was conducted under Project Orbis.
Analytics Help Oncologists ‘Precision Guide’ Care
As clinical knowledge, diagnostic tests and treatments for oncology continue to grow, the focus is narrowing to certain specific genes. But some health insurers, providers and researchers are pushing for a broader approach through a complete genomic profile, which allows for a more precise description of a person with cancer.