As new oral oncolytics enter the market, health plans will not only
have more opportunities to inﬂuence treatment selections for speciﬁc
cancer indications, but by 2015 will look beyond traditional management
strategies to adopt more reﬁned tools and clinical pathways to narrow
The broad selection of new oral oncolytics expected to enter the market in the next few years—including many small molecules that target the same receptor—gives health plans more choices and opportunities to inﬂuence treatment selections for speciﬁc cancer indications. A wide majority of plans (87% in 2012 vs. 77% in 2011) anticipate utilizing a mix of tactics to encourage use of a speciﬁc agent in 2014 if the choice of products treating speciﬁc tumors increases. But the influx of these new oral oncolytics raises an important question:
How will the robust oral oncolytic pipeline shape the way plans manage the category in the next few years?
As a ﬁrst step, plans may apply traditional management tactics, such as step edits and/ or increased member cost sharing, to deter use of less-valued oral oncolytics. More notably, plans will likely reﬁne prior authorization criteria to encourage trials of speciﬁc agents when treatment choice and contracting opportunities exist. Health Strategies Group is closely studying how plans may advantage a speciﬁc oral oncolytic for the treatment of renal cell carcinoma or chronic myeloid leukemia, two cancers for which a choice of oral oncolytic treatment already exists. Near-term plan actions in these two competitive situations will help predict the speed and breadth of plan endorsement of speciﬁc ﬁrst-line oral oncolytics. Pilots of clinical pathways will also lay the foundation for plans to begin narrowing treatment choices by 2015. Over the next three years, plans will create more tumor-speciﬁc pathways (Figure 1), which they will gradually roll out to oncologists in their networks.
To gain ﬁrst-line endorsements by plans, pharmaceutical and biotech companies must successfully convince them of their brands’ clinical advantage. Plans will rigorously evaluate competitive agents, ideally relying on overall survival (OS) data comparing market entrants to current treatment standards using post-launch data. (Figure 2) Health plans will continue to apply traditional management tactics to inﬂuence treatment selections. However, the robust oral oncolytic pipeline will drive health plans to develop and implement increasingly deﬁned prior authorization protocols and tumor- speciﬁc clinical pathways in the next one to two years. speciﬁc clinical pathways in the next one to two years.