Zitter Pulse Check: Prostate Cancer

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 combines deep payer insights with the industry standard in market access information to produce quarterly reports and insights summaries on leading oncology brands.

NCCN Guidelines

Prostate cancer is the most common cancer among men in the U.S., with 12% of men expected to be diagnosed with the condition in their lifetimes. A variety of therapies are available to treat the condition, and the National Comprehensive Cancer Network (NCCN) offers guidelines for their use. Payers with more than half of covered lives say that the guidelines strongly influence their management of prostate cancer, including helping develop their prior-authorization guidelines (see chart).

In addition, almost two-thirds of oncologists say the NCCN guidelines highly influence their prescribing actions. The guidelines provide good evidence-based treatment guidance for different subtypes of prostate cancer, say providers. Many note payers’ reliance on them, which makes it likely that oncologists’ prior-authorization requests would be approved.

Key Findings

PARP Inhibitors

In May 2020, the FDA approved two poly (ADP-ribose) polymerase (PARP) inhibitors to treat certain types of metastatic prostate cancer: AstraZeneca and Merck & Co., Inc.’s Lynparza (olaparib) and Clovis Oncology, Inc.’s Rubraca (rucaparib). Payers with the majority of lives expect to manage the drugs to label. Most oncologists expect to prescribe Lynparza as a second-line therapy and Rubraca as a third-line therapy for the condition. Less than half are likely to prescribe them off-label for earlier use in a treatment regimen. In October 2019, the Janssen Pharmaceutical Companies of Johnson & Johnson said the FDA had given PARP inhibitor Zejula (niraparib) breakthrough therapy designation for certain types of metastatic prostate cancer.

Orgovyx

In December 2020, the FDA approved Myovant Sciences GmbH’s Orgovyx (relugolix), a new oral option to treat advanced prostate cancer. Payers with the vast majority of lives say they will manage the therapy to label. More than three-fourths of oncologists are likely to prescribe the new drug (see chart). More than half expect to prescribe the drug over leuprolide acetate, as well as transition patients currently on that therapy to Orgovyx.

Physician Prescribing

Within the prostate cancer therapeutic class, the top prescribed medications are Xtandi (enzalutamide) from Astellas Pharma US, Inc. and Pfizer Inc. and Zytiga (abiraterone acetate) from Janssen Biotech Inc. Another version of abiraterone acetate, Yonsa from Sun Pharmaceutical Industries, Inc., was the least prescribed drug, with oncologists citing formulary restrictions and lack of cost-effectiveness as their reasons for not prescribing it. Provenge (sipuleucel-T) from Dendreon Pharmaceuticals LLC also was not often prescribed due to its lack of efficacy and cumbersome administration.

Trends

Cost Savings

Message: “Patients with castration-resistant hormone-refractory prostate cancer initiating treatment with Zytiga are best managed using specialty pharmacies. Contract pricing on Zytiga for selected accredited specialty pharmacies will reflect the cost savings of specific support programs and their ability to best manage patient care and optimize outcomes for patients undergoing treatment. Payers, providers and patients can benefit from the cost savings of specialty pharmacy management.”

Payer Thoughts: “The CarePath program will help payers with utilization management and outcomes. This will in turn help decrease costs for specialty medications for patients. Care management is an important part of decreasing costs of treatment in the health care system as a whole.”

PARP Inhibitors OK’d for Prostate Cancer

Although poly (ADP-ribose) polymerase (PARP) inhibitors are not new to the market, two of them — AstraZeneca and Merck & Co., Inc.’s Lynparza (olaparib) and Clovis Oncology, Inc.’s Rubraca (rucaparib) — recently gained approval for use in prostate cancer for the first time. The therapies will bring a new option for the treatment of certain subpopulations of patients.

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

Orgovyx Offers New Oral Option

People being treated for advanced prostate cancer now have a new oral option: Myovant Sciences GmbH’s Orgovyx (relugolix). A recent Zitter Insights survey indicates that the majority of oncologist respondents likely will prescribe it, with many saying they expect to favor it over the current standard of care.

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

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