OBJECTIVES:

The increasing number of oncology combination regimens has highlighted the complexity of multiple manufacturer evaluations. This study aims to assess the dynamics of combination oncology regimen reviews with the Canadian Agency for Drugs and Technologies in Health (CADTH) and the subsequent pricing negotiations through the pan-Canadian Pharmaceutical Alliance (pCPA).

METHODS:

All oncology combination regimens evaluated by CADTH between Q3 2017 and Q3 2022 were assessed to determine whether one or multiple manufacturers submitted to CADTH and which initiated negotiations with pCPA. Multiple factors were reviewed, including manufacturer submitted and CADTH reanalyzed incremental cost-effectiveness ratio (ICERs) and recommended price reductions.

RESULTS:

A total of 32 CADTH submissions were identified in this review, all of which were single manufacturer led. 26 of 32 received a positive clinical recommendation. All required a price reduction to meet the ICER thresholds, with the average difference between submitted and reanalyzed ICERS >300%. 20 of those 26 successfully completed negotiations (7 single- and 13 multi-company). Interestingly, 11 of the multi-company negotiations were led by the submitting manufacturer and the remaining 2 involved both manufacturers in separate confidential negotiations. There are 2 additional multi-company regimens undergoing active pCPA negotiations led by both companies.

CONCLUSIONS:

In most cases, one company led both the CADTH submission and the pricing negotiations. There were however inconsistencies where CADTH reviews required discounts from one or multiple molecules and whether multiple companies were involved in pricing negotiations. Transparency is needed to clarify inconsistency around how combination regimens are handled with CADTH and pCPA.