(324) Discovering current gaps in care and curating health plan best practices in the management of ER+/HER2- mBC: AMCP Market Insights program

Background: : Estrogen receptor-positive/human epidermal growth factor-negative metastatic breast cancer (ER+/HER2- mBC) accounts for 70% of all breast cancer cases and is characterized by favorable overall survival in early stages. However, disparities in progression free survival (PFS) in second-line therapy and beyond highlight an unmet need in the affected patient population.

Objective: : Assess payer perspectives on the management of ER+/HER2- mBC, identify key challenges related to access, and outline best practices to support appropriate drug utilization and coverage decisions within managed care settings.

Methods: : A multidisciplinary virtual forum of managed care oncology experts, a breast cancer specialist, and a patient advocacy representative was held in February 2025 to discuss the clinical, economic, and humanistic considerations surrounding the management of ER+/HER2- mBC. The program included polling questions to quantify participant perspectives and facilitated discussions to generate qualitative insights on managed care strategies and emerging best practices.

Results: : In polling among the 8 participants, 50% cited addressing disparities in care and outcomes as the most important consideration for managing ER+/HER2- mBC. Qualitative insights also called out the need for intensive support services and comprehensive care in the management of patients with ER+/HER2- mBC. Noting an unmet need in second-line therapy with current treatment regimens, investigational treatments offer improvements in progression free survival, which 100% of payer and patient advocacy panelists cited as the most important outcome in ER+/HER2- mBC. Likewise, 100% of participants cited care pathways and/or treatment algorithms for ER+/HER2- mBC, and 60% noted that companion diagnostics play an integral role in coverage policy and utilization management. Qualitative insights highlighted that companion diagnostics coverage lags substantially behind the associated therapy coverage, causing administrative burden and delays in appropriate treatment.

Conclusions: : Payer and patient advocacy representatives acknowledge a need for comprehensive support services in the management of ER+/HER2- mBC, with special consideration given to disparities in care and outcomes. Emerging therapies can potentially address unmet therapeutic needs in second-line therapy and beyond, but payers will be tasked with developing an appropriate coverage policy with timely access to companion diagnostics.

Sponsorship:: Arvinas