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Pricing and Reimbursement of Targeted Cancer Therapies
Decision Resources, Inc., Dec 2009, Pages: 58
Given the life-threatening nature of cancer and the effectiveness and tolerability of many targeted oncology drugs, healthcare payers have typically been willing to provide generous coverage of these therapies. However, the steady increase in spending on these agents is forcing governments and private health insurers to reassess their reimbursement strategies for cancer therapies. In an increasingly cost-conscious environment, pharmaceutical companies must find new ways to justify the cost of high-priced targeted therapies. This report reviews key trends in seven major markets and includes valuable insights from a new survey of 224 U.S. oncologists.
Questions Answered in This Report:
- Healthcare payers around the world have very different approaches to cost sharing for targeted cancer therapies. In the United States, how do commercial and Medicare health plans differ in their cost-sharing strategies? To what extent are European and Japanese patients required to contribute to their treatment costs? What impact does cost sharing have on patient access to targeted therapies?
- In many markets, cancer therapy is administered primarily in hospitals. How do some governments seek to control the use of high-priced cancer therapies by limiting the use of these drugs to the hospital setting or requiring an initial diagnosis by a hospital-based specialist? What are the implications of the growth of prospective payment systems (i.e., reimbursement based on diagnosis-related groups) for funding of innovative cancer therapies?
- Health technology assessment (HTA) will play an increasingly important role in reimbursement decision making for targeted cancer therapies and other high-priced medicines. How has the United Kingdom’s National Institute for Health and Clinical Excellence (NICE) pioneered the use of HTA in making coverage decisions for cancer drugs? What actions are payers in other countries taking to include HTA in their decision making?
- Faced with growing payer resistance to the relatively high prices of targeted cancer therapies, drug manufacturers must devise new ways to demonstrate that their products offer good value for money. What role can companion diagnostics play in making the economic case for targeted therapies? How are payers and pharmaceutical companies using conditional reimbursement to improve patient access to oncology drugs?
Scope:
- International price comparison: comparative analysis of the prices of leading targeted cancer therapies in the United States, France, Germany, Italy, Spain, the United Kingdom, and Japan.
- Physician insights: findings from a new survey of 224 U.S. oncologists regarding the cost and affordability of targeted therapies, physician reimbursement, distribution controls, preferred dosage form, prospects for increased cost-containment, receptiveness to the potential introduction of biosimilars, and reimbursement prospects for new targeted therapies.
- Drug coverage in the United States: comprehensive national data from Fingertip Formulary on formulary positioning and prescribing restrictions for 16 targeted therapies in commercial and Medicare plans.
- Recent developments in the U.S. reimbursement environment: reductions in Medicare hospital outpatient reimbursement; Medicare reforms; expanded Medicare reimbursement of off-label cancer therapy.
- Reimbursement in Europe and Japan: reimbursement of targeted cancer therapies in individual markets; new national cancer strategy in France; prospective requirement for a second opinion on some cancer drugs in Germany; initiatives to improve access to innovative therapies in the United Kingdom.
- Outlook and implications for the pharmaceutical industry: potential impact of U.S. healthcare reform; European prescribing controls; budgetary pressures in the United Kingdom; political change in Japan; increasing importance of health technology assessment; value of companion diagnostics; growth of conditional reimbursement agreements.
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