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Reimbursement Barriers Constrain Prescribing of Zytiga (Abiraterone Acetate), Survey Finds

MCOs commonly restrict access to the drug (Oct. 11)
Surveyed U.S. oncologists indicated that they currently prescribe Zytiga to 41% of their patients with metastatic castrate-resistant prostate cancer who have previously received docetaxel-containing chemotherapy, while only 13% of surveyed urologists indicate that they currently prescribe Zytiga in this setting.

Approximately 40% of oncologists and urologists who prescribe Zytiga indicated that reimbursement barriers (such as prior authorization) strongly constrain their prescribing of Zytiga.

According to surveyed pharmacy directors at managed care organizations (MCOs), Zytiga is currently covered more frequently on unfavorable formulary tiers than on favorable tiers. However, the drug is expected to be included more often on favorable tiers compared with Sanofi’s Jevtana (cabazitaxel injection) within the next 12 months. On the other hand, twice as many commercial plans will cover Dendreon’s Provenge (sipuleucel-T) under their medical benefit compared with Zytiga (26% vs.13%, respectively).

Nearly all surveyed MCO pharmacy directors stated that they restrict access to prostate cancer drugs in some way. Indication restrictions, quantity limits, and prior authorization are frequently used as cost-control measures by pharmacy directors who manage commercial plans in order to restrict access to the most expensive prostate cancer therapies. The high use of quantity limits for Zytiga compared with other agents suggests that some beneficiaries may receive only up to a designated quantity of the drug.

However, only 21% of surveyed Zytiga-prescribing oncologists and no urologists have encountered quantity limits for Zytiga. Prior authorization is most frequently encountered for this drug.

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