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Drug Pricing and Market Access KOL Interview

February 01, 2016

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Highlights

Expensive oncology treatments [PD-1 and upcoming CAR-T therapies] will continue to be covered by large insurers formularies, but access will be restricted according to NCCN guidelines.
Sustainability of healthcare costs is a big question and will be largely dependent on government actions as with recent turn from fee for service to episode of care.
Very large insurers care about long-term cost-savings of curative treatments, but most commercial plans are only looking a year down the road.
PCSK9 drugs may be a coverage concern if in statin failure indication, but coverage would likely be highly managed.
The methodology of this large insurer will not change substantially in response to the lessons learned from Hepatitis C drugs.

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Disease Group Covered:

Cardiovascular
Oncology

Indications Covered:

Castleman's Disease

Additional Resources: