Pricing and Reimbursement in Oncology

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Publication Date: 2006-12-19

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The oncology market has shown remarkable growth in recent years, driven by the advent of targeted therapy and the high level of unmet needs in the disease, and it is poised for further expansion. While this will provide companies with opportunities, a key hurdle for novel cancer drugs will be the increasing pharmacoeconomic vigilance that prevails within cash-strapped healthcare systems.

Scope

  • Evaluate what payer measures for cost-containment in oncology have already been taken or are being planned for the future
  • Maximize the chance of your drug gaining positive payer decisions by recognizing the influences on the reimbursement/funding decision-making process
  • Understand how the oncology pricing and reimbursement environment may evolve over the next five years

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  • Overview of issues surrounding the sustainability of oncology drug pricing and reimbursement, supported by interviews with 23 key payer stakeholders
  • Review of processes involved in getting a new oncology drug approved for payment
  • Evaluation of the level of supporting clinical data, economic data or other value evidence used in the reimbursement decision-making process
  • Assessment of measures for cost-containment in oncology that have already been taken or are being planned for the future

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    Report Highlights
    FDA approval of innovative oncology drugs will guarantee patient access in the US and market uptake is dependent on clinician's perceptions of drug benefit rather than payer constraints. However, this is not the case in the EU where payers have a greater influence on prescribing decisions.

    Drug developers need to be more proactive in initiating and integrating pharmacoeconomic studies concurrent with pivotal clinical trials. Manufacturers also need to shift payer focus away from drug acquisition cost, incorporating a more holistic approach to effectively communicate the value of their drugs.

    Improvement in overall survival from randomized Phase III trials is deemed to be the most desirable outcome by payers. While other endpoints would be given consideration in reimbursement decision-making, payers were of the opinion that these endpoints would support an application based on improved overall survival, rather than as a substitute.

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