Zitter Pulse Check: Prostate Cancer (December 2022)

Coverage

Prostate cancer 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 prostate 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: Prostate Cancer 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 covering more than three-fourths of commercial lives said that managing branded prostate cancer treatments is an average or high priority. Those with slightly less than half of commercial lives and more than half of Medicare lives reported that they are somewhat aggressive in managing those therapies. Half of oncologists expressed average satisfaction with the current treatments for the condition.

Payers representing approximately half of covered lives, as well as about half of oncologists, perceived a moderate unmet need in the treatment of prostate cancer. Payers covering more than three-fourths of lives say that prostate cancer therapies have an average budget impact. Almost half of oncologists say that the treatments have an average out-of-pocket impact on patients.

Key Findings

Physician Prescribing

In the year prior to the survey period, more than half of oncologists prescribed AbbVie Inc.’s Lupron Depot (leuprolide acetate), making it the most frequently prescribed prostate cancer agent. Also commonly prescribed were Xtandi (enzalutamide) from Astellas Pharma US, Inc. and Pfizer Inc. and Zytiga (abiraterone acetate) from the Janssen Pharmaceutical Companies of Johnson & Johnson, both of which also were prescribed by more than half of respondents. Least prescribed were Camcevi (leuprolide) from Accord BioPharma, the U.S. specialty division of Intas Pharmaceuticals, Ltd., which was approved May 25, 2021, but didn’t launch until late March 2022, and Myovant Sciences’ Orgovyx (relugolix), which was approved Dec. 18, 2020, and became available in early January 2021. Both were prescribed by more than a quarter of respondents.

Pluvicto

On March 23, the FDA approved Novartis Pharmaceuticals Corp.’s Pluvicto (lutetium Lu 177 vipivotide tetraxetan) (formerly referred to as ¹⁷⁷Lu-PSMA-617) for the treatment of prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) in people who have been treated with androgen receptor pathway inhibition and taxane-based chemotherapy. The product from Novartis unit Advanced Accelerator Applications USA, Inc. is the first FDA-approved targeted radioligand therapy for eligible people with mCRPC that combines a targeting compound with a therapeutic radioisotope. At the time of the survey, payers with more than three-quarters of commercial covered lives had not conducted a P&T review of the agent. Of those, respondents with a little less than half of lives said they were moderately aware of the product.

Zejula

Janssen’s poly ADP-ribose polymerase (PARP) inhibitor Zejula (niraparib) is in Phase III trials for the treatment, in combination with abiraterone acetate plus prednisone, of people with mCRPC with or without specific homologous recombination repair (HRR) gene alterations. Payers covering almost one-third of commercial lives and almost half of Medicare lives said they were aware that the drug was in development for the treatment of prostate cancer. Once the agent is available, respondents expect the unmet need in treating the condition will decline slightly. Payers covering almost two-thirds of commercial lives said they expect the drug to not impact other available products within the class. Two other PARP inhibitors — AstraZeneca and Merck & Co., Inc.’s Lynparza (olaparib) and Clovis Oncology, Inc.’s Rubraca (rucaparib) — already have FDA approval for metastatic prostate cancer.

Trends

Management

Message: “[Bayer’s Xofigo (radium Ra 223 dichloride)] has been shown to be helpful for those cancers that are no longer responding to low testosterone. This medication will require a pre-authorization. The website has a link which the doctor can fill out the requested form. This will be under Part B for most plans. Patients will pay different copays based on their Part B coverage they signed up for. The manufacturer has a program called Access Services that helps patients and their physician’s office to navigate this process and make it easier for prior authorizations. The health plan has had good results using this service per patient statements. As of now, Medicare covers this medication.”

Payer Thoughts: “Part B is very confusing for patients due to various copay and out-of-pocket costs.”

Novartis’ Pluvicto Brings New Mechanism of Action to mCRPC Options

A new prostate cancer drug is sparking interest among payers and oncologists alike, according to a survey by Zitter Insights. On March 23, 2022, the FDA approved Novartis Pharmaceuticals Corp.’s Pluvicto (lutetium Lu 177 vipivotide tetraxetan) (formerly referred to as ¹⁷⁷Lu-PSMA-617) for the treatment of prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC) in people who have been treated with androgen receptor pathway inhibition and taxane-based chemotherapy. The product from Novartis unit Advanced Accelerator Applications USA, Inc. is the first FDA-approved targeted radioligand therapy for eligible people with mCRPC that combines a targeting compound with a therapeutic radioisotope.

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

CivicaScript Launches Initial Generic Drug, Plans Several More in Coming Years

CivicaScript last week began selling its initial generic drug, a 250 mg abiraterone acetate tablet. It’s the first of what the health insurer- and PBM-backed nonprofit company hopes are many medications that it will produce to help patients and payers lower their drug spending. CivicaScript is offering a 120-tablet bottle of 250 mg abiraterone acetate (a month’s supply) for sale to pharmacies for $160 and is recommending that pharmacies charge no more than $171 per bottle, which is the suggested maximum retail price (MRP) and represents an $11 markup. The combination of abiraterone acetate and prednisone is intended for patients with prostate cancer whose disease has spread to other parts of the body.

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

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