Formulary guidance and transparency from P&T to point of care


Reality Check on Breast Cancer HER2-

Market access for breast cancer (HER2-) treatments reveals differences in payer coverage across each major channel, as well as specific trends in the drug landscape.  

To help make sense of this new research, MMIT's team of experts has analyzed the data for you and summarized the key findings:

  • Payer Insights: Under the pharmacy benefit, about 48% of the lives under commercial formularies are covered with utilization management restrictions
  • Class Trends: In May 2019, the FDA approved Novartis' Piqray (alpelisib) in combination with fulvestrant for the treatment of men and postmenopausal women with hormone receptor positive, human epidermal growth factor receptor-2 negative (HR+/HER2-), PIK3CA-mutated, advanced or metastatic breast cancer as detected by an FDA-approved test whose disease progressed on or after endocrine therapy 
  • Key Findings: It is rare to see a payer place branded products for breast cancer on a preferred tier in the pharmacy benefit, mainly because the majority of products process through the medical benefit. Since many combinations of products are used, no preference is given to one combination over another

What can pharma do to curb this trend and overcome these challenges?

Get the data behind this change and how it could impact your market access plans from MMIT's team. Their clinical and policy backgrounds provide a unique and expert perspective to help expand your knowledge in the class and guide your decision-making process.

Download the full Reality Check now.