Growing Number of Health Plans Will Implement Additional Cost-Sharing Measures to Cover Orally-Administered Oncology Drugs Such

Drugs That Offer Better Survival Data Compared With Other Drugs Well Suited for Reimbursement, According to a New Report from HealthLeaders-InterStudy and Fingertip Formulary

NASHVILLE, Tenn. and GLEN ROCK, N.J., Nov. 23, 2010 /PRNewswire/ -- HealthLeaders-InterStudy and Fingertip Formulary find that over the next five years, a growing number of health plans will shift more of the cost of oral oncology drugs like Novartis' Gleevec, Genentech's Tarceva, AstraZeneca's Arimidex and Bristol Myers Squibb's Sprycel to patients through higher copays and a greater reliance on coinsurance. While this increased use of cost-sharing will be seen across plans of all sizes, plans will find that the cost-sharing will only be minimally effective in lowering costs because of healthcare reform rules that will limit out-of-pocket spending for beneficiaries.

According to the new Formulary Forum report entitled Formulary Advantages in Orally Delivered Oncology Agents, U.S. health plans already restrict the use of oral oncology drugs through prior authorization rules and reimburse only for approved indications. Emerging therapies will also face these restrictions, especially if they are priced higher than existing treatments.

"U.S. health plans examining new oral oncology drugs for inclusion on their formularies are interested in survival data – especially progression-free and overall survival rates," said Senior Analyst Roy Moore. "This means that current and emerging drugs that offer better survival data compared with other drugs will stand the best chance to thrive in this challenging reimbursement environment. For brands that currently have a limited set of progression free survival and overall survival data, there is an opportunity for better reimbursement if these types of survival data are shown in subsequent clinical trials."

The new Formulary Forum report is based on a survey of 50 U.S. pharmacy directors who control formularies at national, regional and state-level managed care organizations, as well as historical formulary data from Fingertip Formulary.

About Fingertip Formulary

Fingertip Formulary (, the leading provider of access to and insight into formulary data in the United States, offers comprehensive formulary data covering commercial, Medicaid, Medicare and PBM plans, among others. Fingertip Formulary is a Decision Resources, Inc. company.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Both HealthLeaders-InterStudy and Fingertip Formulary are Decision Resources, Inc. companies. Please visit Decision Resources, Inc. at

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Erin O'Leary

Elizabeth Marshall


Decision Resources, Inc.



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SOURCE HealthLeaders-InterStudy