Bradley Monk, MD, FACOG, FACS, clinician at Arizona Oncology, professor at the University of Arizona and Creighton University in Phoenix, discusses the reimbursement of PARP inhibitors in ovarian cancer.
Bradley Monk, MD, FACOG, FACS, clinician at Arizona Oncology, professor at the University of Arizona and Creighton University in Phoenix, head of the US Oncology Gynecologic Research Committee, and current co-director for the Gynecologic Oncology Group Research Consortium, discusses the reimbursement landscape of PARP inhibitors in ovarian cancer.
How has the reimbursement landscape for PARP inhibitors evolved since the first one was approved? Do patients have any access issues that are driven by reimbursement decisions?
Reimbursement for PARP inhibition has been universal in the United States and even in Europe. These new frontline PARP inhibitor indications of PRIMA [trial] and the PAOLA-1 [trial]—PRIMA niraparib alone, PAOLA-1 bevacizumab and olaparib—have now been approved in Europe. Europe is trafficking through reimbursement, but in the United States are universally paid for. The only caveat is that in the bevacizumab-olaparib combination there is a companion diagnostic, so generally reimbursement is only for those patients that have the molecular HRD [homologous recombination deficiency] signature.
Even though PARP inhibitors have been paid for through insurances, which is universally true, there are still copays, and copays are the real financial burden. The companies try to support through copay assistance programs, they have foundations, but there still is a substantial financial burden to these expensive oral medications. Someday there'll be generic, and we already have multiple biosimilars for bevacizumab, and we're seeing the prices come down.
So in the end, it's all about value. And the value of PARP inhibitors, obviously, is the most in BRCA-mutated patients—either germline or somatic, it's about the same—but also a lot of value in the HRD, BRCA-like gene subset. The value in the patients that are what we call homologous recombination proficient is not as much, but they're still approved, and certainly there is a value issue with bevacizumab. And when you add bevacizumab and olaparib together, then obviously 2 medications are more expensive than 1.