A new report from HealthLeaders-InterStudy and Fingertip Formulary , leading provider of access to and insight into formulary data, says that drugs that offer better survival data compared with other drugs are well suited for reimbursement. The authors of the report find that over the next five years, a growing number of health plans will shift more of the cost of oral oncology drugs like Novartis’ Gleevec, Genentech’s Tarceva, AstraZeneca’s Arimidex and Bristol Myers Squibb’s Sprycel to patients through higher copays and a greater reliance on coinsurance.
While this increased use of cost-sharing will be seen across plans of all sizes, plans will find that the cost-sharing will only be minimally effective in lowering costs because of healthcare reform rules that will limit out-of-pocket spending for beneficiaries.
According to the new Formulary Forum report entitled Formulary Advantages in Orally Delivered Oncology Agents, U.S. health plans already restrict the use of oral oncology drugs through prior authorization rules and reimburse only for approved indications. Emerging therapies will also face these restrictions, especially if they are priced higher than existing treatments.
“U.S. health plans examining new oral oncology drugs for inclusion on their formularies are interested in survival data ? especially progression-free and overall survival rates,” said Senior Analyst Roy Moore
“This means that current and emerging drugs that offer better survival data compared with other drugs will stand the best chance to thrive in this challenging reimbursement environment. For brands that currently have a limited set of progression free survival and overall survival data, there is an opportunity for better reimbursement if these types of survival data are shown in subsequent clinical trials.”
The new Formulary Forum report is based on a survey of 50 U.S. pharmacy directors who control formularies at national, regional and state-level managed care organizations, as well as historical formulary data from Fingertip Formulary.
