HR-Positive Breast Cancer: Access, Reimbursement, and Treatment Selection with Oral SERDs

This segment examines real-world access and reimbursement considerations influencing the use of oral selective estrogen receptor degraders in hormone receptor–positive, HER2-negative metastatic breast cancer. Dr. Adam Brufsky broadens the discussion to include operational and pharmacy perspectives, highlighting practical challenges in prescribing combination regimens.

Dr. Lisa Raff explains that oral therapies are often processed differently from intravenous treatments, allowing combinations to be dispensed as separate claims, which may increase the likelihood of coverage. However, she emphasizes the importance of clinical justification and supporting evidence when payers request validation.

Dr. Hope S. Rugo reinforces that, despite enthusiasm for combination strategies, single-agent oral SERDs remain effective for selected patients with ESR1-mutated, endocrine-sensitive disease. She also highlights considerations such as tolerability and drug-drug interactions, as well as the growing interest in combining SERDs with pathway-targeted therapies. This segment underscores the balance between clinical evidence, access, and individualized treatment selection.