艾昆纬-癌症患者旅程中的获取挑战-口腔肿瘤学的障碍如何影响患者的开始和坚持（英）

White PaperAccess Challenges in the Cancer Patient JourneyHow barriers to oral oncology affect patient initiation and persistency JEFF THIESEN Managing Principal, U.S. Market Access Strategy Consulting RUTHY GLASS Manager of Thought Leadership, U.S. Market Access Strategy ConsultingCLAUDIA LAMPRECHT Associate Consultant, U.S. Market Access Strategy ConsultingAugust 2024Table of contentsIntroduction 1Overview 2Expanding formulary controls 3Dispensing site effects 9Financial support in oncology 13The past, present, and future of control in oncology 18Notes on sources 19References 20About the authors 21 iqvia.com | 1Oncology is one of the fastest-growing markets in the U.S., with total medicine spending increasing $10 billion to $91 billion from 2022 to 2023.1 As developments in cancer treatment advance, we are now at a point with many tumor types at which multiple options for effective therapy have emerged, and extended survival is leading to increased utilization of those therapies. Market competition and higher volume prompt payers to increase control and raise hurdles to access. The ability for patients to initiate and maintain therapy is crucial for successful treatment and disease management, but we have identified barriers that undercut favorable outcomes.Every day, millions of cancer patients rely on their medications to improve their well-being and survival. Obtaining that therapy is a necessary first step, yet access controls in oncology are expanding, constricting patients’ abilities to start and stay on therapy.Since 2021, IQVIA has been tracking the use of formulary exclusions in oncology medicines affecting both provider- and self-administered treatments.2,3 These controls are on the rise and are growing more impactful as the use of oral oncology products continues to grow, and as payers shift infused oncology products away from the buy-and-bill model into integrated benefit models and favor specialty pharmacies (“white- bagging”) via the pharmacy benefit.4Within the pharmacy benefit, patient access can be impacted by several factors beyond formulary exclusions. A more well-known barrier to access is affordability. As drug prices become a focus of public and political attention, the role that financial support plays in therapy acquisition becomes increasingly pertinent in the discussion of oncology access.Another example is the accessibility of dispensing sites.Optionality and patient choices have become more limited with the use of payer networks that often require or incentivize patients to fill prescriptions via specific pharmacies. These networks are often integrated with the payer and impact specialty medicines more than others.The start of 2024 saw the first wave of changes to the Medicare Part D Benefit design stipulated by the Inflation Reduction Act (IRA). This included the elimination of the 5% patient coinsurance in the Catastrophic phase, which could improve affordability for many patients. However, it is expected shif