AMCP Nexus Survey: Two-Thirds of Payers Use Biosimilars to Manage Oncology Drug Costs

As the cost of oncology drugs increases, there has been a growing pressure to manage oncology drug spend, which some payers have done by establishing preferred therapies, including biosimilars.

As the cost of oncology drugs increases, there has been a growing pressure to manage oncology drug spend. In the past, this sort of management has been difficult for a number of reasons, including that many oral chemotherapy drugs are covered as a Medicare Part D protected class and that cancer has a greater risk of mortality if left untreated.

A new poster presented at the Academy of Managed Care Pharmacy Nexus 2021 meeting assessed payer perceptions and practices regarding oncology therapy management. The authors utilized an online survey in 2020 and a series of interviews in 2021.

A total of 11 payers participated in the survey and 9 in the interviews for 14 unique respondents. These payers oversee 238 million lives. The majority (73%) said they have established preferred oncology products:

  • 75% have preferred therapies for breast cancer
  • 75% have preferred therapies for prostate cancer
  • 38% have preferred therapies for non–small cell lung cancer
  • 25% have preferred therapies for hematologic malignancies
  • 13% have preferred therapies for colon cancer

In addition, 67% said they have established preferred oncology biosimilars vs the originator products. “Other payers also exclude the innovator oncology product from formulary, or require stepping through a biosimilar product prior to covering use of the innovator product,” the researchers wrote.

Among the respondents, 2 reported the exclusion of the innovator product resulted in up to a 30% net cost differential between the biosimilar and originator oncology drug. However, there are challenges impeding biosimilar uptake, such as a lack of interchangeable biosimilars in oncology, administrative burden associated with biosimilar utilization, and a lack of impactful price differentials.

In the next 1 to 3 years, 73% of respondents expect there will be greater management of oncology drugs. Some respondents said they expect their organization will increase management of oncology products in the next 2 years by utilizing tactics such as treatment pathways, site-of-care management, and contracting for favorable formulary tier positioning.

Successful oncology drug management is driven by evidence-based treatment, preventive medicine, reduced costs, and improved patient outcomes, according to the respondents. However, they admit to being only moderately successful on average when it comes to managing oncology drug spend.

Increasing cost of cancer care had the most significant influence on the decision to or the likelihood to prefer products in oncology, followed by development of clinical pathways at the point of prescribing, increased willingness of manufacturers to contract, commoditization of classes of drugs, commoditization of therapeutic areas, and advanced of value frameworks. Vertical integration of the health care landscape had the least influence. Other significant influencers that impact the decision to prefer products, according to 3 respondents, were generic and biosimilar launches, multiple products with the same mechanism of action, and state regulations that limit health plan action.

“To ensure effective market access and payer strategies, manufacturers of oncology products should continually assess the competitive landscape for their product(s), as well as foster their understanding of the evolution of payer management in relevant cancer types,” the authors concluded.

Reference

Clark J, Fortier K, Knoblauch B, Reddan J, Jackson T, Kidder P. Payer perceptions and practices regarding oncology therapy management. Presented at: AMCP Nexus 2021; October 18-21, 2021; Denver, CO. Poster U16.