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Report on reimbursement strategies for cancer therapies

Published on January 8, 2010 at 7:39 AM · No Comments

Research and Markets (http://www.researchandmarkets.com/research/a35234/pricing_and_reimbu) has announced the addition of Decision Resources, Inc.'s new report "Pricing and Reimbursement of Targeted Cancer Therapies" to their offering.

“Pricing and Reimbursement of Targeted Cancer Therapies”

Given the life-threatening nature of cancer and the effectiveness and tolerability of many targeted oncology drugs, healthcare payers have typically been willing to provide generous coverage of these therapies. However, the steady increase in spending on these agents is forcing governments and private health insurers to reassess their reimbursement strategies for cancer therapies. In an increasingly cost-conscious environment, pharmaceutical companies must find new ways to justify the cost of high-priced targeted therapies. This report reviews key trends in seven major markets and includes valuable insights from a new survey of 224 U.S. oncologists.

Questions Answered in This Report:

  • Healthcare payers around the world have very different approaches to cost sharing for targeted cancer therapies. In the United States, how do commercial and Medicare health plans differ in their cost-sharing strategies? To what extent are European and Japanese patients required to contribute to their treatment costs? What impact does cost sharing have on patient access to targeted therapies?
  • In many markets, cancer therapy is administered primarily in hospitals. How do some governments seek to control the use of high-priced cancer therapies by limiting the use of these drugs to the hospital setting or requiring an initial diagnosis by a hospital-based specialist? What are the implications of the growth of prospective payment systems (i.e., reimbursement based on diagnosis-related groups) for funding of innovative cancer therapies?
  • Health technology assessment (HTA) will play an increasingly important role in reimbursement decision making for targeted cancer therapies and other high-priced medicines. How has the United Kingdom's National Institute for Health and Clinical Excellence (NICE) pioneered the use of HTA in making coverage decisions for cancer drugs? What actions are payers in other countries taking to include HTA in their decision making?
  • Faced with growing payer resistance to the relatively high prices of targeted cancer therapies, drug manufacturers must devise new ways to demonstrate that their products offer good value for money. What role can companion diagnostics play in making the economic case for targeted therapies? How are payers and pharmaceutical companies using conditional reimbursement to improve patient access to oncology drugs?

Scope:

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