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.
Lung cancer is the second most common cancer in both men and women, according to the American Cancer Society, and NSCLC makes up 84% of all lung cancers. The NSCLC therapeutic class has multiple options available. In May 2020 alone, the FDA approved seven drugs for the indication. With so many options, commercial payers with about half of covered lives are likely to pursue first-line preferred utilization contracts (see chart).
In addition, almost the same amount likely will not pursue second-line preferred use contracts. Among commercial payers who will seek these contracts, those with almost all covered lives say that Merck & Co., Inc.’s Keytruda (pembrolizumab) will be the top drug pursued for first-line use contracts. AstraZeneca’s Iressa (gefitinib) is the top treatment for second-line use contracting, selected by payers with about two-thirds of covered lives.
Multiple PD-1/PD-L1 agents have been approved as NSCLC treatments. Commercial payers with about one-quarter of covered lives are likely to prefer one of those drugs. But almost half of oncologists are likely to prefer a PD-1/PD-L1 agent over the others, mainly due to efficacy, safety profile and previous experience with the therapy. Keytruda is the drug most likely to be preferred, cited by about three-quarters of oncologists and payers with the majority of covered lives.
Two biosimilars of Roche Group unit Genentech USA, Inc.’s Avastin (bevacizumab) are available: Amgen Inc.’s Mvasi (bevacizumab-awwb) and Pfizer Inc.’s Zirabev (bevacizumab-bvzr). Commercial payers with about one-third of covered lives likely will require the use of the biosimilars in place of Avastin. In 2019, the FDA accepted Samsung Bioepis Co., Ltd.’s application for its bevacizumab biosimilar, known as SB8. Payers with about half of covered lives will not require the use of SB8 in place of Avastin. More than one-third of oncologists will prescribe SB8 in place of other NSCLC treatments.
In May 2020, the FDA approved Novartis Pharmaceutical Corp.’s Tabrecta (capmatinib) to treat MET exon 14 skipping-mutated metastatic NSCLC, making it the first approved drug to target that mutation. Merck KGaA has said it plans to file its FDA application for tepotinib for the same indication in 2020. Commercial payers with almost two-thirds of covered lives likely will manage both agents at parity (see chart). Payers with more than half of covered lives said they likely would cover the drugs per their FDA-approved label. But payers covering more than one-third of lives said that while they will cover the products to label, they also will allow off-label use of them.
Message: “The three-year overall survival data from the PACIFIC trial was recently made available. Imfinzi has become part of the standard of care for NSCLC stage III with curative intent after radiation therapy, so understanding long-term outcomes is very important. The longer-term data shows around a 30% better overall survival over placebo. This is a clinically significant difference and should offer a lot of hope for patients.”
Payer Thoughts: “We always like to see positive survival data. There are so many soft outcomes in oncology that to see the one people actually care about come out positive, we really get excited.”
NSCLC Just Saw Seven FDA Approvals
When the FDA approved Novartis Pharmaceuticals Corp.’s Tabrecta (capmatinib) on May 6, it was the first of seven approvals in non-small cell lung cancer (NSCLC) through May 29. While these will offer more options for people with certain forms of the condition, more treatments are still needed, says one industry expert, and the pipeline is full of an array of therapies.
Payers Likely Will Cover MET Inhibitors
The FDA gave Tabrecta accelerated approval for the treatment of adults with metastatic NSCLC whose tumors have a mutation that leads to mesenchymal-epithelial transition exon 14 skipping (METex14). Commercial payers have indicated a willingness to cover the drug within the first six months of launch, according to data from Zitter Insights.