(308) A survey of healthcare decision maker (HCDM) formulary management perspectives in crowded oncologic markets: a focus on advanced non-small cell lung cancer (aNSCLC) and relapsed/refractory multiple myeloma (RRMM)

Background: : Although novel technology and innovation are driving advances in oncology, many disease areas have crowded markets with multiple treatment options for the same indication and/or drugs sharing the same mechanism of action (MOA). This presents challenges and opportunities for HCDMs in formulary management.

Objective: : To assess HCDMs’ perspectives on formulary management in crowded oncology therapeutic areas proxied by aNSCLC and RRMM.

Methods: : A double-blind, web-based survey was fielded through Cencora’s Managed Care Network from April 17, 2025 to April 15, 2024. The survey utilized hypothetical narratives describing: 1) addition of an oral tyrosine kinase inhibitor (TKI) for 1st or 2nd-line treatment of patients with aNSCLC and a fictitious “XYZ” gene fusion; 2) addition of an injectable antineoplastic with a novel MOA for patients with previously treated RRMM. The hypotheticals included 2 comparator products already on formulary; these 2 products and the fictitious new product had similar efficacy and safety in each scenario. The survey questions assessed HCDM perspectives on formulary considerations and product or disease concerns.

Results: : A total of 20 HCDMs responded to the survey, representing health plans (45%; n=9), integrated delivery networks (30%; n=6), and pharmacy benefits managers (25%; n=5) completed the survey representing national (40%; n=8) and regional (60%; n=12) organizations. Most respondents were pharmacy directors (60%; n=12).
The largest considerations for coverage and reimbursement in both scenarios were cost of therapy (both 55%) and appropriate evidence (25-30%). Approximately three-quarters (70-75%) of respondents reported they would add the new products to formulary, 20-25% reported removing 1 or both current products to add the new product, and 5% in each scenario would not add the new product. Highly ranked product attributes when considering adding oral or injectable products to formulary included durability of therapy, cost, and size of the patient population. Dosing schedule, supportive care and procedures, and novelty of therapeutic platform were not highly ranked considerations.

Conclusions: : Most payers support adding novel oncology products to their formularies, even when differentiation from existing products is minimal. Key drivers in decision-making are clinical evidence (survival, treatment landscape, etc) and cost. These findings offer valuable insights for biopharma companies, highlighting the importance of prioritizing clinical and economic value during clinical development and market access discussions.

Sponsorship:: Cencora