Although Only Forty Percent of Surveyed Commercial MCOs Currently Reimburse the Cost of BRAF Mutation Testing in Malignant Melanoma, This Figure Could Reach 88 Percent in 12 Months, According to a New Report from Decision Resources
BURLINGTON, Mass.--(BUSINESS WIRE)-- Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that Roche/Genentech/Daiichi Sankyo/Chugai's Zelboraf, which received approval by the U.S. Food and Drug Administration (FDA) in August 2011, has already become the patient share leader for B-type Raf kinase (BRAF) mutation-positive malignant melanoma. Zelboraf has quickly become the standard of care and, in 12 months' time, surveyed hospital-based and office-based U.S. oncologists expect Zelboraf to become more deeply ingrained in medical practice for BRAF mutation-positive malignant melanoma. As a result, the proportion of patients receiving chemotherapy will decline due to the market presence of Zelboraf.
The new U.S. Physician & Payer Forum report entitled Dramatic Changes in the Malignant Melanoma Landscape: How Will U.S. Payers and Prescribers Limit or Promote Market Access for Recently Launched and Emerging Brands? also finds that the vast majority of surveyed U.S. oncologists have prescribed Zelboraf and Bristol-Myers Squibb's Yervoy, despite the relatively short period of time that these two agents have been commercially available. The widespread and rapid uptake of Zelboraf and Yervoy is a reflection of the dearth of effective treatment options available for unresectable or metastatic malignant melanoma prior to their launch, and is due to the considerable efficacy gains that both agents confer over other currently available treatments.
The findings also reveal that there is optimism that BRAF/MEK inhibitor combination therapy will show significantly improved efficacy over BRAF inhibitors alone. The majority of surveyed oncologists expect that although first-line treatment with GlaxoSmithKline’s dabrafenib/trametinib will delay treatment resistance compared with a first-line BRAF inhibitor, there is uncertainty over whether the magnitude of efficacy will be sufficient to justify its anticipated high cost.
“The emergence of dabrafenib/trametinib is expected to reduce prescriptions of Zelboraf and dabrafenib/trametinib is expected to surpass Zelboraf as the patient share leader,” said Decision Resources Analyst Rachel Webster, D.Phil.
The report also finds that, although oncologists have embraced BRAF mutation testing, slightly more than one-quarter said they face barriers and challenges with screening. A lack of reimbursement is the most challenging issue for BRAF mutation testing, according to more than one-third of surveyed oncologists. Correspondingly, only 40 percent and 26 percent of commercial and Medicare Advantage plans, respectively, currently reimburse for the BRAF mutation test. Surveyed managed care organizations (MCOs) pharmacy directors cite the test’s limited time on the market as being the most common reason for not reimbursing it, and this is reflected in the large percentage of commercial plans (88 percent) and Medicare Advantage plans (68 percent) that are expected to cover it within the next 12 months.
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Christopher Comfort, 781-993-2597
KEYWORDS: United States North America Massachusetts
INDUSTRY KEYWORDS: Practice Management Health Biotechnology Hospitals Oncology Pharmaceutical Research FDA Science