HIGH-COST ONCOLOGIC MEDICATION ACCESS- WHY IS LATIN AMERICA FALLING BEHIND? CASE STUDY IN NON-SMALL CELL LUNG CANCER (NSCLC)
Author(s)
Lopes G1, Arrieta O2, Bonelli P3, Castano R4, Sehdev S5, Binder L6, Balu S7, Pramanik A8, Duttagupta S9, de Bustamante MM10, de Bustamante MM10
1Hospital do Coração and Oncoclinicas do Brasil group, São Paulo, Brazil, 2Instituto Nacional de Cancerologia, Mexico City, Mexico, 3Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina, 4Organización para la Excelencia de la Salud OES, Bogota, Colombia, 5William Osler Health System, Brampton, ON, Canada, 6CNETS, Toronto, ON, Canada, 7Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA, 8Novartis Pharmaceuticals, East Hanover, NJ, USA, 9CBPartners, New York, NY, USA, 10CB Partners, New York, NY, USA
OBJECTIVES: To understand key market access issues pertaining to reimbursement, HTA policies, guidelines, and ways to improve patient access for innovative oncologic products within Latin America (LA) in comparison to a developed market (Canada). METHODS: A panel of opinion leaders and policy-makers from Brazil, Colombia, Argentina, Mexico, and Canada was convened to understand current challenges in health care, patient access, and reimbursement of high-cost oncologic products with a focus on NSCLC. RESULTS: In LA, patient access to biomarker testing in all cancers is limited, except for common biomarkers like HER2 in breast cancer. In Canada, there is no uniform coverage across provinces for diagnostic testing. In LA, there is an inconsistent and varied level of prioritization in public and private markets amongst various cancers (e.g. breast) for which access to high-cost oncologic agents is more likely. Specifically, NSCLC is not prioritized because of its perceived association with smoking and “poor prognosis”. It is unlikely in LA for expensive medications to be included in the standard benefit packages, and the review process can be lengthy for those that are included. Some patients may get access to some medications through filing a judicial claim against the government for individual drug cost reimbursement. Although various LA countries are witnessing evolution in some form, unlike in Canada, HTA does not have a substantial influence on payer decision-making on drug coverage. There was a consensus for enrolling more patients in clinical trials, development of regional/local clinical guidelines, and generating real-world and cost-effectiveness evidence to potentially improve reimbursement and shorten time to access to medications. CONCLUSIONS: Access to high-cost oncologic medications could be potentially improved through increased patient participation in clinical trials, generation of relevant guidelines and robust cost-effectiveness and evidence-based analyses, and implementation of risk-sharing agreements requiring innovative cancer care models.
Conference/Value in Health Info
2015-09, ISPOR Latin America 2015, Santiago, Chile
Value in Health, Vol. 18, No. 7 (November 2015)
Code
PCN56
Topic
Health Policy & Regulatory, Health Service Delivery & Process of Care, Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes, Health Disparities & Equity, Hospital and Clinical Practices, Reimbursement & Access Policy, Treatment Patterns and Guidelines
Disease
Oncology
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