Presentation (CTI)

OBJECTIVES: Health technology assessment (HTA) increasingly influences patient access to innovative medicines. While previous studies have examined the impact of HTA on reimbursement decisions, less is known about how physicians experience and navigate these systems in clinical practice. This study explored physician perspectives on how HTA and related coverage policies affect access to new blood cancer medicines in England and the United States (US).
METHODS: Semi-structured interviews were conducted with 19 oncologists treating blood cancers between December 2023 and April 2024, including 10 physicians in England and 9 in the US. Interviews explored treatment decision-making, access to innovative therapies, and the influence of payers and HTA on clinical practice. Interviews were audio-recorded, transcribed, and analyzed using reflexive thematic analysis.
RESULTS: Three major themes emerged. First, physicians described a tension between standardization and fragmentation. English physicians reported more consistent treatment pathways but highlighted restrictions resulting from HTA-based coverage decisions. US physicians described broader availability of approved therapies but greater variability due to insurance requirements and prior authorization. Second, physicians identified differing levels of space for innovation. English physicians reported challenges accessing clinically beneficial therapies not recommended by NICE, whereas US physicians described greater flexibility to prescribe newly approved therapies despite administrative barriers. Third, physicians emphasized the role of checks and balances in treatment access. While participants in both countries recognized the need for resource stewardship, many expressed concern that reimbursement decisions could limit access to valuable therapies.
CONCLUSIONS: Physicians in England and the US experience distinct barriers to accessing innovative blood cancer medicines. HTA-based reimbursement decisions in England were perceived to create more explicit restrictions on treatment availability, while US physicians encountered administrative barriers within a broader range of treatment options. These findings suggest that evaluations of medicine access should consider not only coverage decisions but also their effects on physician decision-making and patient care.