Zitter Pulse Check: Non-Small Cell Lung Cancer (June 2023)

Coverage

Non-small cell lung cancer (NSCLC) is a high-cost category with an increasing number of therapies 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 NSCLC, 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

Payers with more than two thirds of covered commercial lives said that managing branded NSCLC drugs was a high or very high priority, while those with slightly less Medicare lives said the same. Those representing almost one-third of commercial beneficiaries and almost one-quarter of Medicare lives said they were aggressive in their management of the agents.

Payers with more than half of commercial lives rated their satisfaction with current NSCLC treatments as average, while those with more than four-fifths of Medicare lives and almost two-thirds of oncologists said the same. Commercial payers with almost three-fourths of beneficiaries said there is high unmet need in treating the disease.

Key Findings

Combination Therapies

As the FDA continues to approve combination therapies for the treatment of NSCLC, payers with more than two-thirds of commercial lives and those with slightly less Medicare lives said they will cover both monotherapies and combination therapies equally, allowing physicians to determine the correct treatment for their patients. Almost two-thirds of oncologists said they have not seen payers take measures to control the use of combination treatments. Payers with less than half of commercial and Medicare beneficiaries said they expect to take steps to control the use of combination agents. Of those respondents, the increased use of prior authorization and step edits, followed by strict adherence to clinical treatment pathways and increased testing requirements were the measures cited most often.

Krazati

On Dec. 12, 2022, the FDA gave accelerated approval to Mirati Therapeutics, Inc.’s Krazati (adagrasib) for the treatment of adults with KRAS G12C-mutated locally advanced or metastatic NSCLC, as determined by an FDA-approved test, who have received at least one systemic therapy. Approximately one-third of payers covering both commercial and Medicare lives had conducted a P&T review by the time of the survey. Among those that had not yet had such a review, payers with more than half of Medicare lives said they expect the new drug to have some impact on their management of other NSCLC therapies, while payers covering more than one-third of commercial lives expect the impact to be moderate. But among Medicare payers that have conducted a P&T review, those with almost all lives said they expect it to have a high impact on NSCLC treatments, meaning that some products that are now covered may not be going forward and/or will have greater use of utilization management criteria.

Companion Diagnostics

Payers covering almost three-fifths of commercial lives and almost all Medicare lives said that their organization covers companion diagnostics for NSCLC treatments. Almost three-fourths of oncologists said they do not prescribe companion diagnostics. Payers with almost two-thirds of commercial lives and those with more than half of Medicare lives require test results from a companion diagnostic in order for patients to gain access to a NSCLC therapy. Among those respondents, payers covering more than four-fifths of commercial lives require test results for specific treatments as opposed to requiring them for all NSCLC agents, while payers with more than half of Medicare beneficiaries require them for only certain drugs.

Trends

Efficacy

Message: “Discussed new indication for NSCLC with a HER2 modification and how Enhertu has been beneficial for these subsets of patients.”

Payer Thoughts: “Impressive with new biomarkers how we now have the ability to pinpoint therapy, whether it had been previously used for that tumor type, and now has relevant information/indication to show positive outcomes. This type of information is exciting and requires a re-evaluation when it comes to branded versus other branded or biosimilars that may not have the same clinical experience.”

People Are Seeing Benefits From Biomarker Testing, but Barriers to Coverage Remain

Biomarker testing is an important tool in cancer care, but a recent survey found payer coverage issues are creating access barriers. According to CancerCare, researchers found that biomarkers helped providers offer personalized care for various cancers for nearly all — 93% — respondents. Twenty percent of surveyed patients were able to forgo unneeded chemotherapy and/or radiation, while 10% found that they were eligible for a clinical trial.

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

FDA Gives Additional Indication to Keytruda

On Jan. 26, 2023, the FDA gave an additional indication to Merck & Co., Inc.’s Keytruda (pembrolizumab) for the adjuvant treatment following surgical resection and platinum-based chemotherapy of adults with stage IB, II or IIIA NSCLC. The agency first approved the programmed death receptor-1 (PD-1) inhibitor on Sept. 4, 2014; the agent now has 34 FDA-approved indications, five of them in NSCLC. Dosing is 200 mg via a 30-minute intravenous infusion every three weeks or 400 mg every six weeks. The drug’s list price when given every three weeks is $10,683.52; the every-six-weeks administration is $21,367.04 per dose.

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

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AIS Health Staff

AIS Health Staff

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