On December 13, 2016, President Obama signed the 21st Century Cures Act. The Act includes several provisions intended to expedite the discovery, development and delivery of new treatments and cures. According to the Global Oncology Trend Report (June 2016) by QuintilesIMS, the pace of innovation in oncology treatments is significant with several cancers being treated with one or more of the 70 new cancer treatments launched within the past five years. To fully translate cancer therapies from the bench to the bedside, health insurance medical and drug benefit designs, including drug formularies, should ensure that the most appropriate treatments are available to the right patients at the right time.
Manatt Health’s analytics team assessed formulary coverage of exchange plans in January 2017 using Managed Markets Insight & Technology (MMIT) data for 113 oncology drugs. Our analysis indicates that cancer drugs recently approved (for their first indication) by the Food and Drug Administration (FDA) are available on fewer exchange plan formularies than those approved in earlier years. (See chart below.) For example, on average, 39 percent of exchange plan formularies cover oncology drugs approved before 2000 compared to just 11 percent that cover oncology drugs approved since 2010. These results highlight the importance of accompanying provisions, such as those included in the 21st Century Cures Act, with initiatives around drug benefit designs and formularies to ensure patients have access to high-value medicines.