Bladder Cancer Pricing, Reimbursement, and Access

Overview

• Payers are concerned about the budget impact of immunotherapies in oncology as a whole, rather than bladder cancer as an indication
• Payers are likely to enter preferential contracts/tenders with immunotherapies in the future
• Roche’s pricing strategy is securing Tecentriq access in the second line
• Opdivo is not reimbursed across Europe in the second line
• Payers may be more lenient with erdafitinib due to its targeted nature

Highlights

• The cost of bladder cancer treatment is not a huge concern for payers due to the relatively small patient numbers, however, they are worried about the overall budget impact of immunotherapies across all indications.
• Checkpoint inhibitors present an attractive target for future contracting due to the high budget impact of the class. However, products must be deemed therapeutically equivalent across a wide breadth of indications before these practices can take place.
• Payers highlight the growing value of time to subsequent therapy as a supportive endpoint for immunotherapies. With many clinical trials now designed to treat until “loss of clinical benefit” rather than progression, payers frequently cite the relevance of this endpoint versus PFS.
• Roche’s competitive pricing strategy is securing Tecentriq access in the second-line setting. Merck & Co is likely to be less willing to reduce the price of Keytruda to account for the uncertainty surrounding the drug’s efficacy in bladder cancer, in order to avoid losing revenue in other, more established indications.
• Opdivo is not recommended for reimbursement in the second-line setting across Europe due to a lack of Phase III data. With no Phase III trial in development, payers indicate that the manufacturers are focusing their efforts on the combination with Yervoy for first-line patients.

Key Questions Answered

• What access controls are currently in place for bladder cancer medicines?
• What new cost-control measures are likely to be implemented in the future?
• What clinical trial evidence do payers desire for immune checkpoint inhibitors?
• How will increased competition among the immunotherapy drug class impact cost?
• How is Roche’s competitive pricing strategy impacting Tecentriq’s access?