In Metastatic Castrate-Resistant Prostate Cancer, Approximately 40 Percent of Oncologists and Urologists who Prescribe Zytiga Indicate that Reimbursement Barriers are a Factor that Strongly Constrains Their Prescribing of Zytiga
Decision Resources
Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that, in a little more than a year after its launch, a sizeable proportion of surveyed U.S. oncologists indicate they are prescribing Johnson & Johnson/Janssen Biotech/Janssen-Cilag's Zytiga according to its approved indication. Surveyed U.S. oncologists indicate they currently prescribe Zytiga to 41 percent of their patients who have previously received docetaxel-containing chemotherapy, while just 13 percent of surveyed urologists indicate that they currently prescribe Zytiga in this setting. Approximately 40 percent of oncologists and urologists who prescribe Zytiga indicate that reimbursement barriers (such as prior authorization) are a factor that strongly constrains their prescribing of Zytiga.
“Prescribing of Zytiga will increase further over the next year, especially among surveyed urologists, and in the chemotherapy-naive setting where we expect Zytiga to secure a label extension” said Decision Resources Analyst Rachel Webster, D. Phil. “Zytiga’s use will see a shift to the first-line chemotherapy-naive setting, particularly in asymptomatic patients, and its quick establishment in this setting will present a hurdle for emerging therapies to win share.”
The new U.S. Physician & Payer Forum report entitled also finds that, if priced at a 20 percent premium or more to the cost of Zytiga, Medivation/Astellas Pharma's Xtandi will secure half the patient share that it would secure if it were priced equal to Zytiga, regardless of its tier placement. Patient share is sufficiently high at lower price points, translating into a higher sales potential for Xtandi within its approved indication than if it were priced at a premium to the cost of Zytiga.
According to surveyed managed care organizations’ (MCOs) pharmacy directors, Zytiga is currently covered more frequently on unfavorable formulary tiers than on favorable tiers. However, in 12 months’ time, Zytiga will be included more frequently on favorable formulary tiers compared with Sanofi’s Jevtana and twice as many commercial plans will cover Dendreon’s Provenge under their medical benefit (26 percent) compared with Zytiga (13 percent). Presence of tier 2 coverage for Zytiga should reduce patient out-of-pocket costs as a hurdle to access.
Among prostate cancer drugs covered in the report, nearly all surveyed MCO pharmacy directors restrict access to these agents in some way. Indication restrictions, quantity limits and prior authorization are frequently employed as cost-control measures by MCO pharmacy directors who manage commercial plans to restrict access to the most expensive prostate cancer therapies. The high use of quantity limits for Zytiga compared with other agents suggests that some beneficiaries may receive only up to a designated quantity of this drug. However, just 21 percent of surveyed Zytiga-prescribing oncologists and no urologists have encountered quantity limits for Zytiga. Conversely, prior authorization is most frequently encountered for Zytiga.
The report also finds that the need for an alpha-pharmaceutical license to administer Algeta/Bayer HealthCare’s radium-223 could deter prescriptions and limit its uptake in the U.S. Sixty-four percent and 52 percent of surveyed oncologists and urologists, respectively, rank this factor among the top three reasons most likely to limit uptake of radium-223. Adequate licensing of sites for the administration of radium-233 could prove critical for maximizing uptake and securing commercial reward in the U.S.
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