Immunotherapy in Oncology
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1 Emerging Markets Market Access & Health Outcomes Immunotherapy in Oncology Comparing and contrasting payer and oncologist perspectives on the impact of a wave of immunotherapies (especially PD-1/PD-L1) on the treatment landscape, oncology costs and downstream effects on management approaches Oncology Epidemiology & Forecasting Marketing Insights Risk Management, Safety & Surveillance Stakeholder Reach Stakeholder Satisfaction Measurement Catalysts driving successful decisions in life sciences
2 The Immunotherapy in Oncology module of Kantar Health s Oncology Market Access (OMA) US explores how oncologists expect immunotherapy will shift the cancer landscape, payers perspectives and what they expect for the future. It also explores how manufacturers may be affected by payers reactions to the expansive growth of the immunotherapy markets. How do oncologists expect immunotherapy will shift the cancer landscape, particularly payers involvement in treatment access? Two-thirds of the oncologists surveyed expect that the availability of new PD-1/PD-L1 drugs will precipitate a shift in the cancer treatment landscape. Oncologists are enthusiastic about disease response rates and unmet needs being addressed, but toxicities both clinical and financial are starting to weigh in on their value assessments. To that end, community oncologists refer approximately 10% of patients eligible for immunotherapy out of the community setting. These referrals out of the community setting are driven by hard-to-manage toxicities, carrying costs and reimbursement risk. Most oncologists felt that payers could not mandate a particular therapy so long as it s prescribed on label, especially given inadequate availability of comparative data. However, they can foresee more payer intervention in the not-too-distant future. Most expect pathways and step therapies to increase where possible. Although highly aware of how difficult it would be, oncologists understood and are anticipating capitation and bundled payments as a way to control costs associated with cancer care in the future. Figure 1: Two-thirds of the oncologists surveyed expect that the availability of new PD-1/PD-L1 drugs will change the cancer landscape 2
3 What are the drivers of payer perspectives, and what do they expect for the future? Payers are more skeptical than oncologists about the potential impact of immunotherapy on the cancer treatment landscape. They are generally impressed by the outcomes, especially where there was a correlation with PD-L1 expression, but acknowledge that biomarker assays as they stand today are still not a viable or accepted means of limiting patient selection. Payers vary significantly in the degree to which they are prepared for the expected wave of approvals: both in clinical savvy to understand their clinical impact and the sophistication needed to manage cost of their utilization. However, they are unanimously aware of the emerging challenge of the additive costs of these therapies, especially in large indications and when used in combination regimens. Figure 2: Payers are more skeptical than oncologists about the potential impact of immunotherapy on the cancer landscape 3
4 How will manufacturers be affected by payers reactions to the expansive growth of the immunotherapy market? With over 500,000 cancer patients who could be eligible for immunotherapy, these emerging treatments herald a new era of both groundbreaking outcomes and burgeoning costs. In the short term, manufacturers can expect more of the same in terms of managing oncology expenditures via utilization management to labelled indication and, with some payers, clinical trial criteria. Assuredly though, these treatments will be covered when appropriately prescribed. Incentives for the selection of preferred products and sharing risk with providers are a couple of years down the road. However, the influx of new therapies and an anticipated astronomical growth of costs will likely increase the will and the way for employers, payers and providers to take more drastic measures to manage rising costs in the next few years. Ultimately, formulary exclusions, new prior authorization criteria and increased financial accountability on physicians are some of the most likely and most easily implemented approaches. Figure 3: Immunotherapies present a conundrum to payers and oncologists 4
5 About the Expert Debbie Warner Vice President, Oncology Commercial Strategies Debbie Warner leads Kantar Health s U.S. and Europe Oncology Commercial Strategies practice. Ms. Warner draws from over 23 years of experience in the pharmaceutical industry in roles spanning sales, account management, medical affairs and managed markets. She brings extensive knowledge of oncology reimbursement, distribution models, patient access to care, specialty pharmacy, pricing and patient assistance programs. She has led multiple projects examining evolving trends in oncology market access and the potential impact of these trends on all key stakeholders. Why Kantar Health Kantar Health is a leading global healthcare consulting firm and trusted advisor to many of the world s leading pharmaceutical, biotech, and medical device and diagnostic companies. It combines evidence-based research capabilities with deep scientific, therapeutic and clinical knowledge, commercial development know-how, and brand and marketing expertise to help clients evaluate opportunities, launch products and maintain brand and market leadership. Our advisory services span three areas critical to bringing new medicines and pharmaceutical products to market commercial development, clinical strategies and marketing effectiveness. 5
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