 PhysicianForum --
December 2006
 In This Issue...
Targeted cancer therapies generated well over $5 billion in
sales in the United States in 2005. Sales of these agents are burgeoning, and
the pipeline for new targeted cancer therapies is bulging. By 2015, Genentech/Roche’s
Avastin alone, one of ten currently targeted therapies launched since 1997,
will account for more than $6 billion in sales in the United States.
Medicare’s role in oncology therapy is crucial
because it funds the treatment of about half of all U.S. cancer patients.
Recent changes to Medicare’s drug reimbursement policies have drastically
altered the way treatment is financed. These changes are impacting the oncologists’
reimbursement structures (and hence the financial incentives under which they
operate), the affordability of cancer therapies, and patient access to
oncologists.
Decision Resources’ PhysicianForum report, "Targeted
Cancer Therapies: Treatment and Reimbursement Issues," explores how reimbursement
issues are affecting the integration of targeted cancer therapies into medical
practice. We surveyed 71 office-based oncologists, 31 hospital oncologists, and
20 HMO pharmacy directors and compared their responses to assess similarities
and differences. This survey enabled Decision Resources to achieve the
following:
- Understand how hospital- and office-based oncologists
differ in their usage of targeted cancer therapies, by drug, tumor type,
and patient age.
- Unravel oncologists’ attitudes to polypharmacy, in
particular understanding oncologists’ attitudes to the magnitude of
benefit that must be conferred by an expensive two-drug combination, in
order to prescribe that combination.
- Uncover alignments and misalignments in the attitudes and
behaviors of clinicians versus HMO directors in factors that will
influence the usage of targeted cancer therapies, for example in attitudes
to biomarker testing, where the priority oncologists place on price may
clash with HMO directors’ focus on cost benefit.
- Analyze the current formulary tier assignments of targeted
cancer therapies based on plan type (including Medicare, Medicare
Advantage, and private plans), and review the level of copayments
associated with each tier and the cost controls imposed by agent and plan
type.
- Understand the constraints that HMOs place upon usage of
targeted agents, including control of off-label usage, dose or duration of
treatment restrictions, and use of specialty pharmacies.
- Gauge how HMOs are planning to alter cost controls, by
agent and plan type, during 2007.
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