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MADISON, NJ – Recent news that the Centers for Medicare & Medicaid Services (CMS) is reviewing the Provenge® immunotherapy for prostate cancer for a National Coverage Determination (NCD) highlights a looming healthcare issue: the increasing costs of innovative cancer therapeutics are on a collision course with reimbursement and authorization controls from healthcare payers. However, an ASCO survey of key payers representing the top 100 private insurance and Medicare plans also shows that clinical study data can lead to quick adoption of new therapies by payers if clinical outcomes and benefit data are robust and indisputable.
In the July ASCO Special Report issue of Oncology Business Review, Rhonda Greenapple, MSPH, President and Founder of Reimbursement Intelligence (RI) discusses crucial findings from the survey conducted by her firm immediately after this year’s ASCO annual meeting, including hot button issues relating to the Provenge®, Tarceva®, and Rituxan® oncology therapeutics and clinical data presented at the meeting.
Rhonda said, “Payers are increasingly focusing on branded cancer therapies to manage costs. As a result, some are responding to new market entrants with growing utilization controls.”
“We found that measureable improvements in overall survival and progression-
“At the same time,” she said, “the results of the survey indicate that therapies that offer a new standard of care or other substantial and indisputable therapeutic improvement, backed by robust clinical data, will be adopted by most payers with few restrictions on access.”
This survey, RI’s second annual post-ASCO analysis, is the kind of primary research Reimbursement Intelligence performs for pharmaceutical and medical device clients, investigating a wide range of therapies, including oncology, rheumatology, Alzheimer’s disease and other medical fields where reimbursement is a key element to market success. RI’s extensive experience in the oncology therapeutic landscape includes access to key payers to understand how they evaluate and reimburse new therapies.
About Reimbursement Intelligence
Reimbursement Intelligence is all about managed care. We help our customers understand how their products will be affected at each stage of the product life cycle, and help them apply that knowledge to strategies and tactics that optimize access and grow sales. We are a multidisciplinary team with over 40 years of experience, focused on delivering global and US managed markets access strategies and pharmaceutical, biotechnology and device companies. For more information, please visit www.reimbursementintelligence.com.
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