HER2+ Breast Cancer Pricing and Reimbursement
HER2+ Breast Cancer Pricing and Reimbursement
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Despite their high prices, Kadcyla and Perjeta are widely reimbursed in the US and have experienced fast uptake as payers have limited options for cost control in this indication.
Publisher: Datamonitor Healthcare
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Despite their high prices, Kadcyla and Perjeta are widely reimbursed in the US and have experienced fast uptake as payers have limited options for cost control in this indication. Once biosimilar versions of Herceptin become available, payers are expected to use patient and physician incentives to drive biosimilar use, including inclusion of biosimilar Herceptin as a preferred on-pathway treatment. In the more cost-constrained markets of Europe, Kadcyla and Perjeta’s high price tags are expected to create a significant barrier to uptake. Consequently, discounting and novel pricing arrangements will be key to achieving access.
Table of Contents
5 EXECUTIVE SUMMARY
6 MARKET CONTEXT
6 High uptake of branded drugs and trastuzumab biosimilars will compensate for the decline in
branded Herceptin sales
6 Pipeline developers are targeting later lines of treatment
6 Marketed HER2-positive breast cancer products in the US, Japan, and five major EU markets
10 Pipeline HER2-positive breast cancer treatments in late-stage development
11 Price assumptions
13 Bibliography
16 US
16 Pricing
17 Reimbursement
24 Bibliography
28 JAPAN
28 Successful pricing outcomes hinge on receipt of a pricing premium
31 Bibliography
32 FIVE MAJOR EU MARKETS
32 Pricing
32 Reimbursement and health technology assessment
54 Bibliography
LIST OF TABLES
6 Table 1: Marketed HER2-positive breast cancer products and approved indications in the US,
Japan, and five major EU markets
11 Table 2: Late-stage candidates in development for HER2-positive breast cancer
11 Table 3: Price sources and calculations, by country
13 Table 4: Exchange rates used for calculating prices
16 Table 5: US pricing of key HER2-positive breast cancer treatments
18 Table 6: Prior authorization criteria for key HER2-positive breast cancer treatments used by
four major health plans
28 Table 7: Japan – pricing premiums given to medicines that can demonstrate benefit over
comparators
29 Table 8: Recent pricing and reimbursement decisions for HER2-positive breast cancer
treatments in Japan
32 Table 9: Monthly cost of treatment (Tykerb) or per mg price (Herceptin, Perjeta, and Kadcyla)
in the five major EU markets
32 Table 10: Transparency Commission’s ASMR ratings and pricing implications
34 Table 11: Transparency Commission’s assessment of HER2-positive breast cancer treatments
39 Table 12: G-BA assessment of key HER2-positive breast cancer treatments
43 Table 13: HER2-positive breast cancer reimbursement decisions in Italy
47 Table 14: NICE assessments of key HER2-positive breast cancer treatments
51 Table 15: SMC decisions on key HER2-positive breast cancer treatments
Table 2: Late-stage candidates in development for HER2-positive breast cancer
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