SOURCE: Reimbursement Intelligence

Reimbursement Intelligence

November 09, 2012 09:48 ET

Reimbursement Intelligence: Payers Struggling to Manage Combination Use of Costly Prostate Cancer Therapies

MADISON, NJ--(Marketwire - Nov 9, 2012) - Forty-seven percent of US payers surveyed indicate they plan to tightly manage the use of combination therapies to treat prostate cancer, according to data released by Reimbursement Intelligence (RI), the New Jersey-based market research firm that helps biopharma, medical device and diagnostics firms succeed in the managed care environment.

As part of an ongoing evaluation of changing payer tactics in oncology, RI surveyed 50 pharmacy and medical directors at regional and national payers representing more than 100 million covered lives about the combination use of costly new oral prostate cancer therapies, such as Zytiga® (abiraterone acetate) and the recently approved Astellas/Medivation compound Xtandi® (enzalutamide).

The RI survey also looked at differences between regional and national plans. "The data were quite striking," said Rhonda Greenapple, chief executive officer of RI. "One-fourth of all national plans would require that a patient fail Zytiga monotherapy before approving a combination regimen, and nearly 20% of these plans said they would cover the combination only if it was on their oncology clinical pathway," she said.

Since Xtandi's September 2012 launch, competitors to Astellas and Medivation and investors have eagerly anticipated script data showing how this new compound fares in an increasingly crowded category. "The release of Medivation's third quarter results is going to be closely watched," Greenapple said.

Noted Greenapple, "The cost of oncologics has become a major hot-button for payers and, increasingly, for providers. The New York Times editorial a few weeks ago by three physicians from Memorial Sloan Kettering explaining why they decided not to offer patients the colorectal medicine Zaltrap® (ziv-aflibercept) should be a loud-and-clear wake-up call to companies that are seeking to launch products that offer no meaningful advantages but are substantially more expensive."

These prostate cancer findings were part of RI's broad-ranging Reimbursement Intelligence Oncology Series (RIOS), an in-depth analysis of how leading payer organizations are approaching the management of oncology care, including their adoption of oncology clinical pathways, formation of oncology ACOs, and attitudes about oral oncologics, biomarkers, and companion diagnostics.

For more information about RIOS, please contact Rhonda Greenapple at or at 973.805.2300.

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