I was quoted in a recent article in Pharmaceutical Technology titled “Targeted therapies to join chemo as oncology treatment backbone“. An excerpt is below:
Though payers could theoretically prioritise chemotherapy over the use of targeted treatments due to their lower price, Jason Shafrin, senior managing director of FTI’s Center for Healthcare Economics and Policy, notes that reducing cost is not a payer’s whole goal. “It’s also about using resources in the best way to improve patient health outcomes; payer decisions will depend on a therapy’s benefit-to-cost ratio,” he says.
In the US, Shafrin believes that private payers are generally more likely to allocate funds to high-cost oncology therapies – including medicines given the greenlight through accelerated approval pathways – over drugs in other areas like cardiovascular disease. This is mostly due to the acute severity of many cancer indications, as well as their “immediate and life-threatening consequences”.
However, Shafrin does acknowledge a discrepancy between the risk appetite of patients and payers. “Many patients will take the risk on a treatment with a potential upside, but payers will often want to know a drug works for sure before reimbursing,” he says.
Shafrin also notes the importance of considering a therapy’s cost on both the patient and system-wide levels. “A lot of targeted cancer therapies are high cost, but they are often only suitable for a smaller patient population who express a specific biomarker,” he says. “As you only use these therapies in a smaller group of patients, the total cost to the system is not necessarily as much as, for example, a cardiovascular drug you’d use across a large population,” Shafrin adds.
According to Shafrin, the level of conservatism demonstrated in payer decisions can also depend on geography. “In Germany, payers are quite strict with cancer therapy reimbursement, as these drugs will often have to show OS benefits to gain coverage.” He contrasts this with the approach of US payers, who he says are increasingly open to accepting established surrogate endpoints as proof of efficacy.
As companies increasingly shift their focus to create oncology drugs that are more convenient for patients, Shafrin does not believe that the administration route will significantly impact payer decisions moving forward.
You can read the full article here.
