The Robust Oral Oncolytic Pipeline

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
treatment options.
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.


  • Susan Weber

    Research Director with Health Strategies Group where she manages the Brand Access Analysis services. Susan has 20 years of diverse healthcare experience with expertise in studying the payer landscape to determine access issues across more than 30 drug categories.


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