Personalized Oncology Can Profoundly Impact Patients Without Negatively Impacting Payers

The era of personalized medicine—particularly in oncology—arrived so quickly and surreptitiously that it was easy to miss. Yet we are very close to the pharmaceutical marketplace everyone dreamed of 25 years ago: one where powerful therapies are developed for increasingly targeted populations, leveraging everything that’s been learned about genetics and biology.

This is a revolution that has almost gone unnoticed. Broadly used cancer medicines have become household names, and the number of curious internet users searching for “personalized medicine” is in a decade-long decline.¹

But the armamentarium of today’s oncology care is better stocked than ever before. Seven cancer medicines were approved by the FDA in 2022 and another 16 were approved in 2021, with many of these developed for small patient populations who have few, if any, options.^2-4

Furthermore, by and large, these treatments are accessible in the United States. For the most part, insurance companies and the pharmacy benefit managers that serve them have created broad access to the diagnostics tools and personalized or targeted treatments that could have the most benefit.

Still, this welcome torrent of treatments carries some questions. For example, oncology spending has been rising.5 This is a natural consequence of the explosion of new and game-changing treatments and can increase concerns about the ability of insurance companies and society in general to continue to ensure access to those drugs for the individuals that need them.

This concern may be especially pronounced for narrow patient populations and the personalized or targeted treatments that are developed for them, as such medicines can be costly. However, the high cost of these drugs can help to fund and progress research and development of targeted treatment options for patient populations that have significant unmet needs.

There are 2 ways that the pharmaceutical industry could address this potential concern:

• Quantify the value of therapies. We have an obligation to quantify the value therapies provide and the impact they have on health care budgets. We have found that undertaking this effort makes clear that breakthrough medicines, smartly targeted at the narrow patient populations most likely to benefit, have the potential to create minimal additional spending for the average insurance company. In one study specific to the non-small cell lung cancer disease space, access to a new targeted therapy could be insured for as little as a penny a month per insurance beneficiary.
• Work more closely with patients. We have a responsibility to work with patients to understand what they really need from oncology drug development. Anyone who has been through the devastation of a cancer diagnosis or who has supported someone through their cancer journey knows how valuable new treatment options can be.

Understanding this experience creates a drive for smart, personalized approaches to cancer, even—or especially—for those with rare cancers. We’ve seen that such medicines do not typically create a burden for payers.

The challenge, then, is not ushering in this new era of personalized therapy—it has long since arrived—but rather nurturing and expanding it. An enormous amount of progress has been made, but there are scientific breakthroughs still yet to be translated into patient benefit. We are confident not only that those new medicines will arrive for the patients who need them most, but also that they will arrive in a system that remains committed to provide access to all patients in need.

About the Author

Luis Hernandez, PhD, MPH, MSc, is the head of Global Health Economics, Global Oncology Patient Value, Policy, and Access at Takeda Oncology. He leads the team responsible for developing the health economics strategy and generating evidence to demonstrate the value of innovative medicines for patients, payers and society to accelerate access across the world, sustainable pricing and valuable partnerships. He has more than 16 years of experience in health economics and outcomes research, evidence generation planning and market access.

References

1. Khoury MJ. The Shift from Personalized Medicine to Precision Medicine and Precision Public Health: Words Matter! CDC website. 2016. Accessed Feb 15, 2023. https://blogs.cdc.gov/genomics/2016/04/21/shift/
2. Hochster HS. 2022: The Oncology Year in Review. Cancer Network. 2022. Accessed Feb 15, 2023. https://www.cancernetwork.com/view/2022-the-oncology-year-in-review
3. 16 Cancer Drugs Approved in 2021. Becker’s Hospital Review, 2021. Accessed Feb 15, 2023. 16 cancer drugs approved in 2021 (beckershospitalreview.com)
4. Center for Drug Evaluation and Research. Oncology (Cancer) / Hematologic Malignancies Approval Notifications. FDA website. Accessed Feb 15, 2023. https://www.fda.gov/drugs/resources-information-approved-drugs/oncology-cancer-hematologic-malignancies-approval-notifications#:~:text=classical%20Hodgkin%20lymphoma-,On%20November%2010%2C%202022%2C%20the%20Food%20and%20Drug%20Administration%20approved,classical%20Hodgkin%20lymphoma%20(cHL)
5. American Cancer Society Cancer Action Network. The Costs of Cancer 2020. American Cancer Society Cancer Action Network. 2020. Accessed Feb 15, 2023. Costs-of-Cancer-2020-10222020.pdf (fightcancer.org)