Expanding Considerations in Oncology Access

<!DOCTYPE html>   <html lang="pt">  <head> <meta charset="utf-8" /> <meta http-equiv="X-UA-Compatible" content="IE=edge"> <meta http-equiv="Content-type" content="text/html; charset=utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1, maximum-scale=1, user-scalable=no"> <meta name="msapplication-TileImage" content="/Content/Shotgun/img/favicon/ms-icon-144x144.png?v=4" /> <link rel="apple-touch-icon-precomposed" href="/Content/Shotgun/img/favicon/apple-icon-precomposed.png?v=4" /> <link rel="icon" href="/Content/Shotgun/img/favicon/favicon.ico?v=4" /><style> .coveo-card-layout a::after { display: none !important; } </style> <script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-P97VBCW');</script> <meta name="google-site-verification" content="EyIQB7GdOQ83t4xrzV8zE-Gs_mjfgD-VO1TZkSkbKSc" />  <title>Expanding Considerations in Oncology Access - IQVIA</title>  <link rel="canonical" href="https://www.iqvia.com/locations/united-states/blogs/2023/05/expanding-considerations-in-oncology-access" /> <meta name="keywords" content="blog, oncology, Medicare, chemotherapy, Longitudinal Access and Adjudication Data, LAAD, cancer patient, treatment journey, oncolytic, Inflation Reduction Act, IRA, Market Access, Cancer, Payer exclusions, tumor" /> <meta name="description" content="While the number of treatments has increased over time, the ability for oncology patients to access and initiate their therapy still remains a looming challenge for many. " /> <meta name="iq:related_solutions" content="Brand & Marketing, Market Access, Commercial Solutions" /> <meta name="iq:blog_tags" content="Market Access" /> <meta name="iq:insight_topics" content="Market Access,Commercialization,Digital Health" /> <meta name="iq:united_states_insight_topics" content="Brand and Marketing,Commercial Strategy" /> <meta name="iq:market_product" content="IQVIA" /> <meta name="iq:region" content="North America" /> <meta name="iq:regional_business_unit" content="US and Canada" /> <meta name="iq:business_area" content="Enterprise" /> <meta name="iq:thought_leadership" content="" /> <meta property="og:title" content="Expanding Considerations in Oncology Access" /> <meta property="twitter:title" content="Expanding Considerations in Oncology Access" /> <meta property="og:image" content="https://www.iqvia.com/-/media/iqvia/images/modules/brandworld/1099_woman-with-cancer-tablet-at-home.jpg" /> <meta property="twitter:image" content="https://www.iqvia.com/-/media/iqvia/images/modules/brandworld/1099_woman-with-cancer-tablet-at-home.jpg" /> <meta property="og:description" content="<p><strong>Introduction</strong></p> <p>One of the fastest growing areas in healthcare is the oncology market, in terms of the use of therapeutics, healthcare spending, and in the number of products in development<sup>1</sup>. Behind these advancements are millions of patients living their lives with a life-altering disease. While the number of treatments has increased over time, the ability for patients to access and initiate their therapy still remains a looming challenge for many.</p> <p>Some of these challenges are well documented. A recent IQVIA paper highlighted how payer exclusions of oncology treatments, despite often being considered an unofficially protected class, are growing at top PBMs<sup>2</sup>. Additionally, the cost of cancer medications can be prohibitive for many patients. Though Commercial patients heavily rely on manufacturer-sponsored copay cards to reduce costs, Standard Eligible Medicare patients do not have the ability to use copay cards and must rely on foundations to offset costs.</p> <p>However, there are additional factors in a patient&rsquo;s journey that have less-studied effects on therapy initiation and maintenance. One of these factors is the order in which a new clinical intervention or therapy is presented during a patient&rsquo;s treatment progression, often referred to as line of therapy. From a clinical perspective, lines of therapy can include interventions like surgery, radiation, chemotherapy, or therapeutics, either injectables or orals. Every time a patient completes a recommended intervention duration or begins a new type of treatment, they are considered to have progressed to a new line of therapy.</p> <p>Patients can progress through lines of therapy for many reasons, including intervention efficacy, safety, and durable effect on disease progression. Around three-quarters of all oncology patients progress past a first line of therapy, with around one-quarter making it to at least a third line (data not shown). Recently, the ubiquity of targeted oral oncology treatments has grown; however, they are very often utilized as later-line treatments, as prescribers and insurers may perceive them as either unproven or significantly costlier compared to older, more established treatments. IQVIA is able to track a patient&rsquo;s journey within our Longitudinal Access and Adjudication Data (LAAD) dataset, and in doing so, can shed light onto barriers to access that may be subtle impediments to either starting or staying on treatment.</p> <p><strong>Payer control and line of therapy</strong></p> <p>Payer control in oncology has been growing over the past several years, making it increasingly difficult for patients to access their medications<sup>3</sup>. Among Commercial or Medicare cancer patients, over 70% prescribed a new oral targeted therapy are initially rejected by their insurers (Figure 1). Almost half of these rejected patients are needing to meet additional Prior Authorization requirements (data not shown). Unfortunately, as a patient&rsquo;s disease progresses and they move through lines of therapy, there is very little change in Commercial and Medicare insurer willingness to approve these targeted oral therapies. Contrary to common belief, a second- or third-line therapy is not immune to the access barriers of a first-line therapy.</p> <p><strong>Figure 1: Initial and durable new patient approval, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/41ec8baee6a24859b2de5d4afe1b9ed6.ashx" style="height:484px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; A 90-day look-forward window is applied from the time of initial attempt to durable claim status<br /> Source: IQVIA LAAD data; US Market Access Strategy Consulting</em></p> <p>Secondly, as patients experience these rejections in later lines of therapy, the likelihood that they opt for no treatment is likely to double (Figure 2). Patients rejected after attempting a second- or third-line oral therapy fail to ever fill another oncology treatment at a far greater rate than those rejected on their first treatment. For patients that do fill another treatment after a rejection, many opt for another targeted therapy, while others fill harsher treatments such chemotherapy or radiation. Access barriers are difficult enough for patients and can lead to a change in their treatment trajectory, but when combined with an attempt later in treatment progression, they can lead to overall increased patient drop-off.</p> <p><strong>Figure 2: Post-rejection treatment history, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/6f1f4f23d62a42b49f4df4b85f1c36d2.ashx" style="height:482px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; Patients must have at least 30 days of data post-durable rejection to be included<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p><strong>Patient abandonment and line of therapy</strong></p> <p>Conversely, among patients whose prescriptions are approved by their insurers, the cost they are required to pay can also be prohibitive. While some level of prescription abandonment due to cost is generally expected, the rate of abandonment among cancer patients progressing through lines of therapy increases substantially (Figure 3). Among both Commercial and Medicare cancer patients, the proportion of patients who abandon therapy between their first and second line of therapy doubles. This is most pronounced for Standard Medicare patients, that is those who do not receive additional government help or subsidies, with almost one-third of approved patients abandoning therapy. Among all patients, an even greater proportion abandon therapy as they progress to the next line of therapy.</p> <p><strong>Figure 3: New patient abandonment, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/ad886b3088ca4da7b39bc9531cfaf49e.ashx" style="height:482px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; A 90-day look-forward window is applied from the time of approval to final abandonment status<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p>However, the increase in therapy abandonment is not always cost-related. In fact, abandonment increases as line-of-therapy progresses in every patient out-of-pocket cost cohort, including for patients facing no copay whatsoever (Figure 4). Irrespective of cost, patients who have filled prior treatments are more likely not to fill a subsequent one. Put together, though prescription abandonment is a reality in the oncology market, the factors that exist which prevent patients from filling prescriptions are exacerbated by where a patient is in their treatment process. Prescribing an oral oncolytic as a second- or third-line treatment inherently increases the probability of a patient choosing to ultimately forego filling it.</p> <p><strong>Figure 4: New patient abandonment by patient out-of-pocket cost, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/7350f9cb57c449f6b9a520949ec67cb9.ashx" style="height:485px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; A 90-day look-forward window is applied from the time of approval to final abandonment status<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p>For patients who abandon oral therapy as their first line of treatment, almost all eventually fill another treatment (Figure 5). For patients who choose to abandon oral treatment when it is their second line, 33% of Commercial and 39% of Standard Medicare patients never fill another oncology treatment. This proportion is even greater for patients who abandon a third or greater line of therapy. For patients who have been exposed to even just one treatment already, the choice to give up on a subsequent therapy tends to be a permanent one. </p> <p><strong>Figure 5: Post-abandonment treatment history, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/aeba8c44b85845bf937cd599983a48fb.ashx" style="height:488px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; Patients must have at least 30 days of data post-abandonment to be included<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p><strong>Discussion</strong></p> <p>A wide variety of factors impact a cancer patient&rsquo;s treatment journey; although, not all of them are as obvious as others. Payer control and patient choice dynamics on treatment initiation are well-known, but many believe that these barriers apply only to new patients at the start of their treatment. As this blog has shown, that is a misconception. Not only are second- and third-line patients facing similar rejection rates to first-line patients, but abandonment rates increase, and a greater proportion of patients fall off therapy completely.</p> <p>Patients in later line therapies represent a previously understated group facing considerable market access challenges. With the rise in formulary exclusions in oncology and the documented harmful effect prior authorizations play on patient outcomes<sup>4</sup>, patients who are more advanced in their disease face the same or greater barriers to accessing treatment as those just beginning the process. Additionally, as the onset of the Inflation Reduction Act (IRA) looms and payers will be responsible for the majority of costs in the Catastrophic phase of Medicare coverage &ndash; with a lower $2,000 out-of-pocket for patients &ndash; possible tighter control for expensive medicines, like oral oncolytics, is expected in Medicare. The effects of the IRA on Commercial patients are still unknown, but spill-over effects on utilization management are anticipated. This, together with the increased abandonment and patient drop-off in later lines, reveals an increasingly prohibitive landscape for cancer patients at all stages in the disease.</p> <p>At the heart of all this is the patient. Patients must face the obstacles to life-saving medications and must make the choice of what their future treatment journey will look like. As highlighted here, the choice to initiate and continue care is more complex than just the obvious factors of approval and affordability, and until more of the obscure aspects of the patient journey, such as line of therapy, are considered, there will always be unanswered questions about the patients who seem to fall through the cracks.</p> <p>For more information, or if you have questions about this topic, please reach out to us at <a href="mailto:market_access_thought_leadership@iqvia.com">market_access_thought_leadership@iqvia.com</a>.</p> <p>&nbsp;</p> <p><strong>References</strong></p> <ol style="font-size: 75%;"> <li><a rel="noopener noreferrer" href="https://www.iqvia.com/insights/the-iqvia-institute/reports/the-global-use-of-medicines-2023" target="_blank">https://www.iqvia.com/insights/the-iqvia-institute/reports/the-global-use-of-medicines-2023</a></li> <li><a rel="noopener noreferrer" href="https://www.iqvia.com/locations/united-states/library/white-papers/controlling-cancer-care-the-expansion-of-formulary-exclusions-in-oncology" target="_blank">https://www.iqvia.com/locations/united-states/library/white-papers/controlling-cancer-care-the-expansion-of-formulary-exclusions-in-oncology</a></li> <li>Ibid.</li> <li>ASCO Prior Authorization Survey, December 2022; <a rel="noopener noreferrer" href="https://old-prod.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/prior-authorization" target="_blank">Prior Authorization | ASCO</a></li> </ol>" /> <meta property="twitter:description" content="<p><strong>Introduction</strong></p> <p>One of the fastest growing areas in healthcare is the oncology market, in terms of the use of therapeutics, healthcare spending, and in the number of products in development<sup>1</sup>. Behind these advancements are millions of patients living their lives with a life-altering disease. While the number of treatments has increased over time, the ability for patients to access and initiate their therapy still remains a looming challenge for many.</p> <p>Some of these challenges are well documented. A recent IQVIA paper highlighted how payer exclusions of oncology treatments, despite often being considered an unofficially protected class, are growing at top PBMs<sup>2</sup>. Additionally, the cost of cancer medications can be prohibitive for many patients. Though Commercial patients heavily rely on manufacturer-sponsored copay cards to reduce costs, Standard Eligible Medicare patients do not have the ability to use copay cards and must rely on foundations to offset costs.</p> <p>However, there are additional factors in a patient&rsquo;s journey that have less-studied effects on therapy initiation and maintenance. One of these factors is the order in which a new clinical intervention or therapy is presented during a patient&rsquo;s treatment progression, often referred to as line of therapy. From a clinical perspective, lines of therapy can include interventions like surgery, radiation, chemotherapy, or therapeutics, either injectables or orals. Every time a patient completes a recommended intervention duration or begins a new type of treatment, they are considered to have progressed to a new line of therapy.</p> <p>Patients can progress through lines of therapy for many reasons, including intervention efficacy, safety, and durable effect on disease progression. Around three-quarters of all oncology patients progress past a first line of therapy, with around one-quarter making it to at least a third line (data not shown). Recently, the ubiquity of targeted oral oncology treatments has grown; however, they are very often utilized as later-line treatments, as prescribers and insurers may perceive them as either unproven or significantly costlier compared to older, more established treatments. IQVIA is able to track a patient&rsquo;s journey within our Longitudinal Access and Adjudication Data (LAAD) dataset, and in doing so, can shed light onto barriers to access that may be subtle impediments to either starting or staying on treatment.</p> <p><strong>Payer control and line of therapy</strong></p> <p>Payer control in oncology has been growing over the past several years, making it increasingly difficult for patients to access their medications<sup>3</sup>. Among Commercial or Medicare cancer patients, over 70% prescribed a new oral targeted therapy are initially rejected by their insurers (Figure 1). Almost half of these rejected patients are needing to meet additional Prior Authorization requirements (data not shown). Unfortunately, as a patient&rsquo;s disease progresses and they move through lines of therapy, there is very little change in Commercial and Medicare insurer willingness to approve these targeted oral therapies. Contrary to common belief, a second- or third-line therapy is not immune to the access barriers of a first-line therapy.</p> <p><strong>Figure 1: Initial and durable new patient approval, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/41ec8baee6a24859b2de5d4afe1b9ed6.ashx" style="height:484px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; A 90-day look-forward window is applied from the time of initial attempt to durable claim status<br /> Source: IQVIA LAAD data; US Market Access Strategy Consulting</em></p> <p>Secondly, as patients experience these rejections in later lines of therapy, the likelihood that they opt for no treatment is likely to double (Figure 2). Patients rejected after attempting a second- or third-line oral therapy fail to ever fill another oncology treatment at a far greater rate than those rejected on their first treatment. For patients that do fill another treatment after a rejection, many opt for another targeted therapy, while others fill harsher treatments such chemotherapy or radiation. Access barriers are difficult enough for patients and can lead to a change in their treatment trajectory, but when combined with an attempt later in treatment progression, they can lead to overall increased patient drop-off.</p> <p><strong>Figure 2: Post-rejection treatment history, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/6f1f4f23d62a42b49f4df4b85f1c36d2.ashx" style="height:482px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; Patients must have at least 30 days of data post-durable rejection to be included<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p><strong>Patient abandonment and line of therapy</strong></p> <p>Conversely, among patients whose prescriptions are approved by their insurers, the cost they are required to pay can also be prohibitive. While some level of prescription abandonment due to cost is generally expected, the rate of abandonment among cancer patients progressing through lines of therapy increases substantially (Figure 3). Among both Commercial and Medicare cancer patients, the proportion of patients who abandon therapy between their first and second line of therapy doubles. This is most pronounced for Standard Medicare patients, that is those who do not receive additional government help or subsidies, with almost one-third of approved patients abandoning therapy. Among all patients, an even greater proportion abandon therapy as they progress to the next line of therapy.</p> <p><strong>Figure 3: New patient abandonment, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/ad886b3088ca4da7b39bc9531cfaf49e.ashx" style="height:482px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; A 90-day look-forward window is applied from the time of approval to final abandonment status<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p>However, the increase in therapy abandonment is not always cost-related. In fact, abandonment increases as line-of-therapy progresses in every patient out-of-pocket cost cohort, including for patients facing no copay whatsoever (Figure 4). Irrespective of cost, patients who have filled prior treatments are more likely not to fill a subsequent one. Put together, though prescription abandonment is a reality in the oncology market, the factors that exist which prevent patients from filling prescriptions are exacerbated by where a patient is in their treatment process. Prescribing an oral oncolytic as a second- or third-line treatment inherently increases the probability of a patient choosing to ultimately forego filling it.</p> <p><strong>Figure 4: New patient abandonment by patient out-of-pocket cost, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/7350f9cb57c449f6b9a520949ec67cb9.ashx" style="height:485px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; A 90-day look-forward window is applied from the time of approval to final abandonment status<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p>For patients who abandon oral therapy as their first line of treatment, almost all eventually fill another treatment (Figure 5). For patients who choose to abandon oral treatment when it is their second line, 33% of Commercial and 39% of Standard Medicare patients never fill another oncology treatment. This proportion is even greater for patients who abandon a third or greater line of therapy. For patients who have been exposed to even just one treatment already, the choice to give up on a subsequent therapy tends to be a permanent one. </p> <p><strong>Figure 5: Post-abandonment treatment history, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="-/media/aeba8c44b85845bf937cd599983a48fb.ashx" style="height:488px; width:1180px;" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; Patients must have at least 30 days of data post-abandonment to be included<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p><strong>Discussion</strong></p> <p>A wide variety of factors impact a cancer patient&rsquo;s treatment journey; although, not all of them are as obvious as others. Payer control and patient choice dynamics on treatment initiation are well-known, but many believe that these barriers apply only to new patients at the start of their treatment. As this blog has shown, that is a misconception. Not only are second- and third-line patients facing similar rejection rates to first-line patients, but abandonment rates increase, and a greater proportion of patients fall off therapy completely.</p> <p>Patients in later line therapies represent a previously understated group facing considerable market access challenges. With the rise in formulary exclusions in oncology and the documented harmful effect prior authorizations play on patient outcomes<sup>4</sup>, patients who are more advanced in their disease face the same or greater barriers to accessing treatment as those just beginning the process. Additionally, as the onset of the Inflation Reduction Act (IRA) looms and payers will be responsible for the majority of costs in the Catastrophic phase of Medicare coverage &ndash; with a lower $2,000 out-of-pocket for patients &ndash; possible tighter control for expensive medicines, like oral oncolytics, is expected in Medicare. The effects of the IRA on Commercial patients are still unknown, but spill-over effects on utilization management are anticipated. This, together with the increased abandonment and patient drop-off in later lines, reveals an increasingly prohibitive landscape for cancer patients at all stages in the disease.</p> <p>At the heart of all this is the patient. Patients must face the obstacles to life-saving medications and must make the choice of what their future treatment journey will look like. As highlighted here, the choice to initiate and continue care is more complex than just the obvious factors of approval and affordability, and until more of the obscure aspects of the patient journey, such as line of therapy, are considered, there will always be unanswered questions about the patients who seem to fall through the cracks.</p> <p>For more information, or if you have questions about this topic, please reach out to us at <a href="mailto:market_access_thought_leadership@iqvia.com">market_access_thought_leadership@iqvia.com</a>.</p> <p>&nbsp;</p> <p><strong>References</strong></p> <ol style="font-size: 75%;"> <li><a rel="noopener noreferrer" href="https://www.iqvia.com/insights/the-iqvia-institute/reports/the-global-use-of-medicines-2023" target="_blank">https://www.iqvia.com/insights/the-iqvia-institute/reports/the-global-use-of-medicines-2023</a></li> <li><a rel="noopener noreferrer" href="https://www.iqvia.com/locations/united-states/library/white-papers/controlling-cancer-care-the-expansion-of-formulary-exclusions-in-oncology" target="_blank">https://www.iqvia.com/locations/united-states/library/white-papers/controlling-cancer-care-the-expansion-of-formulary-exclusions-in-oncology</a></li> <li>Ibid.</li> <li>ASCO Prior Authorization Survey, December 2022; <a rel="noopener noreferrer" href="https://old-prod.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/prior-authorization" target="_blank">Prior Authorization | ASCO</a></li> </ol>" /> <meta property="og:url" content="https://www.iqvia.com/pt-br/locations/united-states/blogs/2023/05/expanding-considerations-in-oncology-access" /> <meta property="twitter:site" content="https://www.iqvia.com/pt-br/locations/united-states/blogs/2023/05/expanding-considerations-in-oncology-access" /> <link href="/Content/Shotgun/css/coveo?v=5f2TXK9t8FlC_0aw4cAoVYcmCiwv63sB9xo1gz4KnGg1" rel="stylesheet"/> <link 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href="https://www.iqvia.com/locations/hungary">Hungary</a></li> <li><a href="https://www.iqvia.com/locations/ireland">Ireland</a></li> <li><a href="https://www.iqvia.com/locations/israel">Israel</a></li> <li><a href="https://www.iqvia.com/it-it/locations/italy">Italia</a></li> </ul> <ul class="sub-list" style="float:left"> </ul> <ul class="sub-list" style="float:left"> <li><a href="https://www.iqvia.com/nl-nl/locations/netherlands">Nederland</a></li> <li><a href="https://www.iqvia.com/locations/nordics">Nordics</a></li> <li><a href="https://www.iqvia.com/pl-pl/locations/poland">Poland</a></li> <li><a href="https://www.iqvia.com/pt-pt/locations/portugal">Portugal</a></li> <li><a href="https://www.iqvia.com/locations/romania">Romania</a></li> <li><a href="https://www.iqvia.com/locations/russia">Russia</a></li> <li><a href="https://www.iqvia.com/locations/slovakia">Slovakia</a></li> <li><a href="https://www.iqvia.com/locations/switzerland">Switzerland</a></li> <li><a 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align-center"> <a class="list-item-style text-decoration-none after-none" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/medical-specialty-societies">Medical Specialty and Patient Advocacy</a> <div class="icon"> <svg xmlns="http://www.w3.org/2000/svg" width="7.029" height="12" viewBox="0 0 7.029 12"> <g id="Chevron" transform="translate(-135.26 -19.823)"> <rect id="Rectangle_125" data-name="Rectangle 125" width="8.521" height="1.42" rx="0.71" transform="translate(136.264 19.823) rotate(45)" fill="#959ca0"></rect> <rect id="Rectangle_126" data-name="Rectangle 126" width="8.521" height="1.42" rx="0.71" transform="translate(135.26 30.819) rotate(-45)" fill="#959ca0"></rect> </g> </svg> </div> </li> </ol> </div> <div class="w-80 tab-content solutions"> <div class="item h-100 default-content mt-0"> </div> <div class="item bg h-100 align-center"> <div class="d-flex align-center w-100 "> <div class="w-33"> <h3>Pharmaceutical Manufacturers</h3> <p>Harness unparalleled healthcare data, advanced analytics, and cutting-edge technologies with our expertise to accelerate the development and commercialization of innovative medicines, enhancing patient lives.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences" style="max-width: 303px;">Harness Data</a> </div> <div class="w-33"> <h6 class="pt-0 border-left pb-11 mt-0">Pharmaceutical Manufacturers</h6> <ol class="border-left"> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/commercial-solutions">Commercial Solutions</a></li> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/contract-sales-and-medical-solutions">Contract Sales and Medical Solutions</a></li> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/digital-enablement-center-of-excellence">Digital Enablement Center of Excellence</a></li> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/information-solutions">Information Solutions</a></li> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/medical-affairs">Medical Affairs</a></li> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/real-world-evidence">Real World Evidence</a></li> </ol> </div> </div> </div> <div class="item bg h-100 align-center"> <div class="d-flex align-center w-100 no-links"> <div class="w-33"> <img src="/-/media/iqvia/images/modules/brandworld/920_group-of-people-looking-at-data-during-business-meeting.jpg?h=683&w=1024&hash=9F1D12445AA35397B08A93A0D4506A73"> </div> <div class="w-33"> <h3>Emerging Biopharma (Global page)</h3> <p>Boost your innovation with IQVIA's expert team. Our comprehensive solutions integrate top-tier insights, technology, and expertise to maximize your asset's success in a competitive landscape.</p> <a class="btn" href="https://www.iqvia.com/pt-br/solutions/industry-segments/emerging-biopharma" style="max-width: 303px;">Discover Innovations</a> </div> </div> </div> <div class="item bg h-100 align-center"> <div class="d-flex align-center w-100 "> <div class="w-33"> <h3>MedTech</h3> <p>Navigating MedTech's unique landscape: U.S. decision-making now rests with GPOs, IDNs, and payers, who demand solid value proof through rigorous outcomes analyses and pricing scrutiny.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment" style="max-width: 303px;">Explore MedTech</a> </div> <div class="w-33"> <h6 class="pt-0 border-left pb-11 mt-0">MedTech</h6> <ol class="border-left"> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/commercial-field-solutions">Commercial Field Solutions</a></li> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/hospital-procedures-and-diagnosis">Hospital Procedures and Diagnosis</a></li> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/medical-device-supply-audit">Medical Device Supply Audit</a></li> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/medtech-business-insights-and-trends-podcast-series">MedTech Business Insights and Trends Podcast Series</a></li> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/medtech-market-activator-platform">MedTech Market Activator Platform</a></li> </ol> </div> </div> </div> <div class="item bg h-100 align-center"> <div class="d-flex align-center w-100 no-links"> <div class="w-33"> <img src="/-/media/iqvia/images/modules/brandworld/441_custom-photo_two-professionals-focused-on-laptop-information---copy_600.jpg?h=683&w=1024&hash=6C0045E8A4B73FC243BD062B0CE70586"> </div> <div class="w-33"> <h3>Financial Institutions</h3> <p>Invest in healthcare with confidence. Stay ahead of pharma and medical device trends using real-time, high-quality data. Access market insights, historical sales, prescription trends, and emerging product information for informed, risk-reduced decisions.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/financial-services" style="max-width: 303px;">Access Insights</a> </div> </div> </div> <div class="item bg h-100 align-center"> <div class="d-flex align-center w-100 "> <div class="w-33"> <h3>Government and Public Health</h3> <p>Unlock deeper health insights with unmatched data and innovative technology to enhance decision-making for your essential government programs.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/government-segment" style="max-width: 303px;">Unlock Innovations</a> </div> <div class="w-33"> <h6 class="pt-0 border-left pb-11 mt-0">Government and Public Health</h6> <ol class="border-left"> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/government-segment/government-solutions">CIO-CS</a></li> </ol> </div> </div> </div> <div class="item bg h-100 align-center"> <div class="d-flex align-center w-100 no-links"> <div class="w-33"> <img src="/-/media/iqvia/images/modules/brandworld/490_custom-photo_professional-carefully-reviewing-data-information.jpg?h=683&w=1024&hash=3C77D651DBA851B8FED8D62CDCB4CFC6"> </div> <div class="w-33"> <h3>Health Plans</h3> <p>Accelerate digital innovation with our data-driven expertise in data science and healthcare, optimizing business processes for smarter decisions.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/payers-segment" style="max-width: 303px;">Navigate Health Plans</a> </div> </div> </div> <div class="item bg h-100 align-center"> <div class="d-flex align-center w-100 "> <div class="w-33"> <h3>Hospital and Health Systems</h3> <p>Leverage digital innovation to cut costs, boost efficiency, and elevate patient engagement, all while enhancing quality and health outcomes.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/providers-segment" style="max-width: 303px;">Streamline Decisions</a> </div> <div class="w-33"> <h6 class="pt-0 border-left pb-11 mt-0">Hospital and Health Systems</h6> <ol class="border-left"> <li class="hover-color-blue"><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/providers-segment/hospital-data-exchange-program">Hospital Data Exchange Program</a></li> </ol> </div> </div> </div> <div class="item bg h-100 align-center"> <div class="d-flex align-center w-100 no-links"> <div class="w-33"> <img src="/-/media/iqvia/images/modules/brandworld/2137_it-professionals-programming-in-coding-language.png?h=576&w=1024&hash=E95DC0942533073BFAC07BFBCA46877D"> </div> <div class="w-33"> <h3>Insurers and Risk</h3> <p>Enhance your ability to evaluate and forecast population risk swiftly and accurately by integrating unmatched data, expertise, and technology. </p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/insurer-and-risk-solutions" style="max-width: 303px;">Evaluate Risk</a> </div> </div> </div> <div class="item bg h-100 align-center"> <div class="d-flex align-center w-100 no-links"> <div class="w-33"> <img src="/-/media/iqvia/images/modules/brandworld/2436_doctor-and-nurse-with-digital-tablet-talking.png?h=619&w=1024&hash=98E8877207191BDCEB7979FB8FB2BDF8"> </div> <div class="w-33"> <h3>Medical Specialty and Patient Advocacy</h3> <p>Transform into a data-driven organization that enhances your specialty and showcases value to your members through digital transformation. </p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/medical-specialty-societies" style="max-width: 303px;">Enhance Your Specialty</a> </div> </div> </div> </div> </div> </div> </div> </div> </div> </li> <li> <a class="color-white" href="#">Insights</a> <div class="primary-nav-wrapper"> <div class="content insights"> <div class="shadow"></div> <div class="d-flex remove-last"> <div class="w-50"> <div class="d-flex pt-75"> <div class="w-50"> <h5>U.S. PROGRESS POINT</h5> <p>A curation of IQVIA's best thinking on topics and trends driving change, disruption, and progress in the United States healthcare market.</p> <a class="hover-color-blue-with-anim" href="https://www.iqvia.com/pt-br/locations/united-states/us-progress-point"> LEARN MORE <div class="icon"> <svg xmlns="http://www.w3.org/2000/svg" width="7.029" height="12" viewBox="0 0 7.029 12"> <g id="Chevron" transform="translate(-135.26 -19.823)"> <rect id="Rectangle_125" data-name="Rectangle 125" width="8.521" height="1.42" rx="0.71" transform="translate(136.264 19.823) rotate(45)" fill="#959ca0"></rect> <rect id="Rectangle_126" data-name="Rectangle 126" width="8.521" height="1.42" rx="0.71" transform="translate(135.26 30.819) rotate(-45)" fill="#959ca0"></rect> </g> </svg> </div> </a> </div> <div class="w-50"> <h5>BLOGS, WHITE PAPERS & CASE STUDIES</h5> <p>Explore our library of insights, thought leadership, and the latest topics & trends in healthcare.</p> <a class="hover-color-blue-with-anim" href="https://www.iqvia.com/pt-br/locations/united-states/insights"> DISCOVER INSIGHTS <div class="icon"> <svg xmlns="http://www.w3.org/2000/svg" width="7.029" height="12" viewBox="0 0 7.029 12"> <g id="Chevron" transform="translate(-135.26 -19.823)"> <rect id="Rectangle_125" data-name="Rectangle 125" width="8.521" height="1.42" rx="0.71" transform="translate(136.264 19.823) rotate(45)" fill="#959ca0"></rect> <rect id="Rectangle_126" data-name="Rectangle 126" width="8.521" height="1.42" rx="0.71" transform="translate(135.26 30.819) rotate(-45)" fill="#959ca0"></rect> </g> </svg> </div> </a> </div> </div> </div> <div class="w-65"> <div class="d-flex"> <div class="w-33"> <div class="card-wrapper"> <div class="card"> <img src="/-/media/iqvia/images/modules/brandworld/2447_woman-watching-business-training-on-laptop-and-learning-from-home.jpg?h=800&w=1200&hash=7138103CD56C8FC464E41DA86DD886F0"> <h5 class="title">PODCASTS</h5> <p class="description">Discover the future through our enlightening podcasts available in the United States.</p> <a class="hover-color-blue-with-anim" href="https://www.iqvia.com/locations/united-states/insights#f:type=[Podcast]"> EXPLORE PODCASTS <div class="icon"> <svg xmlns="http://www.w3.org/2000/svg" width="7.029" height="12" viewBox="0 0 7.029 12"> <g id="Chevron" transform="translate(-135.26 -19.823)"> <rect id="Rectangle_125" data-name="Rectangle 125" width="8.521" height="1.42" rx="0.71" transform="translate(136.264 19.823) rotate(45)" fill="#959ca0"></rect> <rect id="Rectangle_126" data-name="Rectangle 126" width="8.521" height="1.42" rx="0.71" transform="translate(135.26 30.819) rotate(-45)" 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development and commercialization of innovative medicines, enhancing patient lives.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences">Harness Data</a> <div class="hr"></div> <h6>Pharmaceutical Manufacturers</h6> <ul> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/commercial-solutions">Commercial Solutions</a></li> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/contract-sales-and-medical-solutions">Contract Sales and Medical Solutions</a></li> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/digital-enablement-center-of-excellence">Digital Enablement Center of Excellence</a></li> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/information-solutions">Information Solutions</a></li> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/medical-affairs">Medical Affairs</a></li> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/real-world-evidence">Real World Evidence</a></li> </ul> </div> <div class="tab-item"> <img src="/-/media/iqvia/images/modules/brandworld/920_group-of-people-looking-at-data-during-business-meeting.jpg?h=683&w=1024&hash=9F1D12445AA35397B08A93A0D4506A73"> <h5>Emerging Biopharma (Global page)</h5> <p>Boost your innovation with IQVIA's expert team. Our comprehensive solutions integrate top-tier insights, technology, and expertise to maximize your asset's success in a competitive landscape.</p> <a class="btn w-auto mt-30" href="https://www.iqvia.com/pt-br/solutions/industry-segments/emerging-biopharma">Discover Innovations</a> </div> <div class="tab-item"> <h5>MedTech</h5> <p>Navigating MedTech's unique landscape: U.S. decision-making now rests with GPOs, IDNs, and payers, who demand solid value proof through rigorous outcomes analyses and pricing scrutiny.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment">Explore MedTech</a> <div class="hr"></div> <h6>MedTech</h6> <ul> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/commercial-field-solutions">Commercial Field Solutions</a></li> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/hospital-procedures-and-diagnosis">Hospital Procedures and Diagnosis</a></li> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/medical-device-supply-audit">Medical Device Supply Audit</a></li> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/medtech-business-insights-and-trends-podcast-series">MedTech Business Insights and Trends Podcast Series</a></li> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/medical-device-and-diagnostic-segment/medtech-market-activator-platform">MedTech Market Activator Platform</a></li> </ul> </div> <div class="tab-item"> <img src="/-/media/iqvia/images/modules/brandworld/441_custom-photo_two-professionals-focused-on-laptop-information---copy_600.jpg?h=683&w=1024&hash=6C0045E8A4B73FC243BD062B0CE70586"> <h5>Financial Institutions</h5> <p>Invest in healthcare with confidence. Stay ahead of pharma and medical device trends using real-time, high-quality data. Access market insights, historical sales, prescription trends, and emerging product information for informed, risk-reduced decisions.</p> <a class="btn w-auto mt-30" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/life-sciences/financial-services">Access Insights</a> </div> <div class="tab-item"> <h5>Government and Public Health</h5> <p>Unlock deeper health insights with unmatched data and innovative technology to enhance decision-making for your essential government programs.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/government-segment">Unlock Innovations</a> <div class="hr"></div> <h6>Government and Public Health</h6> <ul> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/government-segment/government-solutions">CIO-CS</a></li> </ul> </div> <div class="tab-item"> <img src="/-/media/iqvia/images/modules/brandworld/490_custom-photo_professional-carefully-reviewing-data-information.jpg?h=683&w=1024&hash=3C77D651DBA851B8FED8D62CDCB4CFC6"> <h5>Health Plans</h5> <p>Accelerate digital innovation with our data-driven expertise in data science and healthcare, optimizing business processes for smarter decisions.</p> <a class="btn w-auto mt-30" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/payers-segment">Navigate Health Plans</a> </div> <div class="tab-item"> <h5>Hospital and Health Systems</h5> <p>Leverage digital innovation to cut costs, boost efficiency, and elevate patient engagement, all while enhancing quality and health outcomes.</p> <a class="btn" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/providers-segment">Streamline Decisions</a> <div class="hr"></div> <h6>Hospital and Health Systems</h6> <ul> <li><a href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/providers-segment/hospital-data-exchange-program">Hospital Data Exchange Program</a></li> </ul> </div> <div class="tab-item"> <img src="/-/media/iqvia/images/modules/brandworld/2137_it-professionals-programming-in-coding-language.png?h=576&w=1024&hash=E95DC0942533073BFAC07BFBCA46877D"> <h5>Insurers and Risk</h5> <p>Enhance your ability to evaluate and forecast population risk swiftly and accurately by integrating unmatched data, expertise, and technology. </p> <a class="btn w-auto mt-30" href="https://www.iqvia.com/pt-br/locations/united-states/solutions/healthcare-solutions/insurer-and-risk-solutions">Evaluate Risk</a> </div> <div class="tab-item"> <img src="/-/media/iqvia/images/modules/brandworld/2436_doctor-and-nurse-with-digital-tablet-talking.png?h=619&w=1024&hash=98E8877207191BDCEB7979FB8FB2BDF8"> <h5>Medical Specialty and Patient Advocacy</h5> <p>Transform into a data-driven organization 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19.823) rotate(45)" fill="#959ca0"></rect> <rect id="Rectangle_126" data-name="Rectangle 126" width="8.521" height="1.42" rx="0.71" transform="translate(135.26 30.819) rotate(-45)" fill="#959ca0"></rect> </g> </svg> </div> </a> </div> </div> </div> <div class="item-wrapper-mobile list " data-attribute="contactus"> <div class="breadcrumbs"><span class="go-home">MAIN</span>/<span>Contact Us</span></div> <div class="breadcrumbs d-none" style="padding-bottom:30px;"><span class="go-main">Contact Us</span>/<span></span></div> <div class="lists"> </div> </div> </div> </div> </div> </div> </header>  <section class="insights-detail-hero-redesign charcoal__bg"> <div class="insights-detail-hero-outer"> <div class="insights-detail-hero-outer-top"> <div class="insights-detail-hero-outer-content"> <div class="top-part">Blog</div> <div class="title">Expanding Considerations in Oncology Access</div> <div class="subtitle">As cancer raises the stakes for patients, payer hurdles to access are unrelenting</div> <div class="date"> <div class="author"> <div>Jeff Thiesen, Managing Principal, U.S. Market Access Strategy Consulting, IQVIA</div> <div>Jing Yang, Principal, U.S. Market Access Strategy Consulting, IQVIA</div> <div>Ruthy Glass, PhD, Manager, U.S. Market Access Strategy Consulting, IQVIA</div> </div> <div class="time">May 18, 2023</div> </div> </div> </div> <div class="hero-breadcrumbs padding z_index breadcrumbs-hero_outer"> <div class="breadcrumbs breadcrumbs-hero_inner"> <ul class="breadcrumbs__list"> <li class="breadcrumbs__item"> <a href="https://www.iqvia.com/pt-br/"><span class="iqvia-icon-home"></span></a> </li> <li class="breadcrumbs__item"> <a href="https://www.iqvia.com/pt-br/locations">Locations</a> </li> <li class="breadcrumbs__item"> <a href="https://www.iqvia.com/pt-br/locations/united-states">United States</a> </li> <li class="breadcrumbs__item"> <a href="https://www.iqvia.com/pt-br/locations/united-states/blogs">US Blogs</a> </li> <li class="breadcrumbs__item"> <span>Expanding Considerations in Oncology Access</span> </li> </ul> </div> </div> </div> </section> <section class="share-bar-redesign"> <div class="share-bar-wrapper"> <button class="share-bar-container"> <p> Share PAGE <img alt="Share PAGE" src="/Content/Shotgun/img/icons/social_icons/new/Share.svg" /> </p> <ul class="dropdown"> <li title="Copy link to clipboard" data-event="copy"> <span>Copy Link</span> <img src="/Content/Shotgun/img/icons/social_icons/new/Copy.svg" /> </li> </ul> </button> </div> </section> <section class="insights-detail-body-redesign "> <div class="insights-detail-body-redesign__outer"> <div class="insights-detail-body-redesign__inner"> <p><strong>Introduction</strong></p> <p>One of the fastest growing areas in healthcare is the oncology market, in terms of the use of therapeutics, healthcare spending, and in the number of products in development<sup>1</sup>. Behind these advancements are millions of patients living their lives with a life-altering disease. While the number of treatments has increased over time, the ability for patients to access and initiate their therapy still remains a looming challenge for many.</p> <p>Some of these challenges are well documented. A recent IQVIA paper highlighted how payer exclusions of oncology treatments, despite often being considered an unofficially protected class, are growing at top PBMs<sup>2</sup>. Additionally, the cost of cancer medications can be prohibitive for many patients. Though Commercial patients heavily rely on manufacturer-sponsored copay cards to reduce costs, Standard Eligible Medicare patients do not have the ability to use copay cards and must rely on foundations to offset costs.</p> <p>However, there are additional factors in a patient’s journey that have less-studied effects on therapy initiation and maintenance. One of these factors is the order in which a new clinical intervention or therapy is presented during a patient’s treatment progression, often referred to as line of therapy. From a clinical perspective, lines of therapy can include interventions like surgery, radiation, chemotherapy, or therapeutics, either injectables or orals. Every time a patient completes a recommended intervention duration or begins a new type of treatment, they are considered to have progressed to a new line of therapy.</p> <p>Patients can progress through lines of therapy for many reasons, including intervention efficacy, safety, and durable effect on disease progression. Around three-quarters of all oncology patients progress past a first line of therapy, with around one-quarter making it to at least a third line (data not shown). Recently, the ubiquity of targeted oral oncology treatments has grown; however, they are very often utilized as later-line treatments, as prescribers and insurers may perceive them as either unproven or significantly costlier compared to older, more established treatments. IQVIA is able to track a patient’s journey within our Longitudinal Access and Adjudication Data (LAAD) dataset, and in doing so, can shed light onto barriers to access that may be subtle impediments to either starting or staying on treatment.</p> <p><strong>Payer control and line of therapy</strong></p> <p>Payer control in oncology has been growing over the past several years, making it increasingly difficult for patients to access their medications<sup>3</sup>. Among Commercial or Medicare cancer patients, over 70% prescribed a new oral targeted therapy are initially rejected by their insurers (Figure 1). Almost half of these rejected patients are needing to meet additional Prior Authorization requirements (data not shown). Unfortunately, as a patient’s disease progresses and they move through lines of therapy, there is very little change in Commercial and Medicare insurer willingness to approve these targeted oral therapies. Contrary to common belief, a second- or third-line therapy is not immune to the access barriers of a first-line therapy.</p> <p><strong>Figure 1: Initial and durable new patient approval, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="/-/media/iqvia/images/united-states/blogs/2023/05/oncology-abandonment-blog_image-1.jpg" style="width:1180px;" class="img-responsive" data-img-height="484px" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; A 90-day look-forward window is applied from the time of initial attempt to durable claim status<br /> Source: IQVIA LAAD data; US Market Access Strategy Consulting</em></p> <p>Secondly, as patients experience these rejections in later lines of therapy, the likelihood that they opt for no treatment is likely to double (Figure 2). Patients rejected after attempting a second- or third-line oral therapy fail to ever fill another oncology treatment at a far greater rate than those rejected on their first treatment. For patients that do fill another treatment after a rejection, many opt for another targeted therapy, while others fill harsher treatments such chemotherapy or radiation. Access barriers are difficult enough for patients and can lead to a change in their treatment trajectory, but when combined with an attempt later in treatment progression, they can lead to overall increased patient drop-off.</p> <p><strong>Figure 2: Post-rejection treatment history, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="/-/media/iqvia/images/united-states/blogs/2023/05/oncology-abandonment-blog_image-2.jpg" style="width:1180px;" class="img-responsive" data-img-height="482px" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; Patients must have at least 30 days of data post-durable rejection to be included<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p><strong>Patient abandonment and line of therapy</strong></p> <p>Conversely, among patients whose prescriptions are approved by their insurers, the cost they are required to pay can also be prohibitive. While some level of prescription abandonment due to cost is generally expected, the rate of abandonment among cancer patients progressing through lines of therapy increases substantially (Figure 3). Among both Commercial and Medicare cancer patients, the proportion of patients who abandon therapy between their first and second line of therapy doubles. This is most pronounced for Standard Medicare patients, that is those who do not receive additional government help or subsidies, with almost one-third of approved patients abandoning therapy. Among all patients, an even greater proportion abandon therapy as they progress to the next line of therapy.</p> <p><strong>Figure 3: New patient abandonment, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="/-/media/iqvia/images/united-states/blogs/2023/05/oncology-abandonment-blog_image-3.png" style="width:1180px;" class="img-responsive" data-img-height="482px" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; A 90-day look-forward window is applied from the time of approval to final abandonment status<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p>However, the increase in therapy abandonment is not always cost-related. In fact, abandonment increases as line-of-therapy progresses in every patient out-of-pocket cost cohort, including for patients facing no copay whatsoever (Figure 4). Irrespective of cost, patients who have filled prior treatments are more likely not to fill a subsequent one. Put together, though prescription abandonment is a reality in the oncology market, the factors that exist which prevent patients from filling prescriptions are exacerbated by where a patient is in their treatment process. Prescribing an oral oncolytic as a second- or third-line treatment inherently increases the probability of a patient choosing to ultimately forego filling it.</p> <p><strong>Figure 4: New patient abandonment by patient out-of-pocket cost, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="/-/media/iqvia/images/united-states/blogs/2023/05/oncology-abandonment-blog_image-4.jpg" style="width:1180px;" class="img-responsive" data-img-height="485px" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; A 90-day look-forward window is applied from the time of approval to final abandonment status<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p>For patients who abandon oral therapy as their first line of treatment, almost all eventually fill another treatment (Figure 5). For patients who choose to abandon oral treatment when it is their second line, 33% of Commercial and 39% of Standard Medicare patients never fill another oncology treatment. This proportion is even greater for patients who abandon a third or greater line of therapy. For patients who have been exposed to even just one treatment already, the choice to give up on a subsequent therapy tends to be a permanent one. </p> <p><strong>Figure 5: Post-abandonment treatment history, oral targeted therapy, all tumor types, 2020-2022</strong></p> <p><strong><img alt="" src="/-/media/iqvia/images/united-states/blogs/2023/05/oncology-abandonment-blog_image-5.jpg" style="width:1180px;" class="img-responsive" data-img-height="488px" /></strong></p> <p style="font-size: 75%;"><em>Note: Tumor types include breast, lymphoma, leukemia, prostate, and non-small cell lung cancer; Patients must have at least 30 days of data post-abandonment to be included<br /> Source: IQVIA LAAD data, US Market Access Strategy Consulting</em></p> <p><strong>Discussion</strong></p> <p>A wide variety of factors impact a cancer patient’s treatment journey; although, not all of them are as obvious as others. Payer control and patient choice dynamics on treatment initiation are well-known, but many believe that these barriers apply only to new patients at the start of their treatment. As this blog has shown, that is a misconception. Not only are second- and third-line patients facing similar rejection rates to first-line patients, but abandonment rates increase, and a greater proportion of patients fall off therapy completely.</p> <p>Patients in later line therapies represent a previously understated group facing considerable market access challenges. With the rise in formulary exclusions in oncology and the documented harmful effect prior authorizations play on patient outcomes<sup>4</sup>, patients who are more advanced in their disease face the same or greater barriers to accessing treatment as those just beginning the process. Additionally, as the onset of the Inflation Reduction Act (IRA) looms and payers will be responsible for the majority of costs in the Catastrophic phase of Medicare coverage – with a lower $2,000 out-of-pocket for patients – possible tighter control for expensive medicines, like oral oncolytics, is expected in Medicare. The effects of the IRA on Commercial patients are still unknown, but spill-over effects on utilization management are anticipated. This, together with the increased abandonment and patient drop-off in later lines, reveals an increasingly prohibitive landscape for cancer patients at all stages in the disease.</p> <p>At the heart of all this is the patient. Patients must face the obstacles to life-saving medications and must make the choice of what their future treatment journey will look like. As highlighted here, the choice to initiate and continue care is more complex than just the obvious factors of approval and affordability, and until more of the obscure aspects of the patient journey, such as line of therapy, are considered, there will always be unanswered questions about the patients who seem to fall through the cracks.</p> <p>For more information, or if you have questions about this topic, please reach out to us at <a href="mailto:market_access_thought_leadership@iqvia.com">market_access_thought_leadership@iqvia.com</a>.</p> <p> </p> <p><strong>References</strong></p> <ol style="font-size: 75%;"> <li><a rel="noopener noreferrer" href="https://www.iqvia.com/insights/the-iqvia-institute/reports/the-global-use-of-medicines-2023" target="_blank">https://www.iqvia.com/insights/the-iqvia-institute/reports/the-global-use-of-medicines-2023</a></li> <li><a rel="noopener noreferrer" href="https://www.iqvia.com/locations/united-states/library/white-papers/controlling-cancer-care-the-expansion-of-formulary-exclusions-in-oncology" target="_blank">https://www.iqvia.com/locations/united-states/library/white-papers/controlling-cancer-care-the-expansion-of-formulary-exclusions-in-oncology</a></li> <li>Ibid.</li> <li>ASCO Prior Authorization Survey, December 2022; <a rel="noopener noreferrer" href="https://old-prod.asco.org/news-initiatives/current-initiatives/cancer-care-initiatives/prior-authorization" target="_blank">Prior Authorization | ASCO</a></li> </ol> </div> </div> </section> <section class="fifty-fifty-redesign"> <div class="fifty-fifty-redesign__outer" data-aos="fade-up"> <div class="fifty-fifty-redesign__wrapper"> <div class="fifty-fifty-redesign__inner"> <div class="fifty-fifty-redesign__image"> <div class="fifty-fifty-redesign__image-box"> <img 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