Though all three drugs provide therapeutic breakthroughs by extending life expectancy for patients with advanced prostate cancer, the extension is measured in months, not years. This has sparked a great deal of excitement among patients and oncologists, but proves only a minor victory from the payer perspective. With several other new prostate cancer agents in the pipeline, payer anxiety is rising over the need to enact effective restrictions to limit off-label (and expensive) use without blocking the appropriate use of these ground-breaking therapies.
New payer restrictions on the use of prostate cancer agents mirror the evolution of oncology management, which is getting tighter and more restrictive across the board. According to The Zitter Group’s Prior Authorization Tracking Tool, though most oncology agents targeted for tighter management do not currently face fully developed PA criteria, payer efforts to limit use are being enacted.
The Prior Authorization Tracking Tool is a detailed database of health plan prior authorization policies for more than 350 commercial and government payers. Key highlights from the recent report on prostate cancer include:
- The shift by payers to more restrictive phases of management has been slower in prostate cancer than other tumor types, renal cell carcinoma in particular
- Larger payers are moving to later phases of management faster than smaller payers
- Nearly 50% of payers currently cover Jevtana and Provenge without a PA, though national payers and Blues Affiliates are more likely to have a PA in place
- Though all three drugs do extend life expectancy, the extension is measured in months – sparking excitement among oncologists, but considered only a minor victory from the payer perspective
- With several other new prostate cancer agents in the pipeline, payer anxiety in the category is rising and management efforts are likely to follow
- While management by payers is tightening, it is still focused on ensuring appropriate use of prostate cancer agents
- The next phase in payer management of prostate cancer will be experimentation with policy language to determine the proper “levers” to pull to reduce inappropriate utilization
ABOUT THE ZITTER GROUP
The Zitter Group is a business intelligence firm that assists life science companies with issues related to product access, reimbursement, and managed markets. Founded in 1989, The Zitter Group provides data-driven business insights derived from the nation’s largest payer research panel. The company produces the largest and most detailed database on prior authorization policies, several of the largest syndicated studies on payer management of specialty and oncology drugs, and the only service tracking messages account managers provide to payers. For additional information on The Zitter Group, please visit http://www.zitter.com.
ABOUT THE PRIOR AUTHORIZTATION TRACKING TOOL
The Prior Authorization Tracking Tool is the largest database of detailed health plan prior authorization policies and metrics from more than 350 commercial and government payers. This comprehensive, interactive database employs a proprietary system to quantify the restrictiveness of each plan’s PA to help pharmaceutical managed care marketing and sales professionals understand the scope of PA- influenced access across accounts, the impact of restrictiveness on geographic populations and market share, and the competitive climate of a given drug category.
