Emerging Markets Physician and Payer Forum

November 2013

Breast Cancer in China and South Korea: Physician and Payer Insight into Market Access Drivers

Report Authors
Amy Duval, M.Res.
  • Pages:89
  • Tables:10
  • Figures:120
  • Citations:0
  • Drugs:10
  • Interviews:7


Increasingly, it has become clear that there is no one size fits all model for the treatment of breast cancer. Informed by better understanding of disease pathogenesis, companies have developed agents that target specific subpopulations of breast cancer patients. This report will examine the barriers facing premium-priced therapies for the treatment of breast cancer, molecular testing for targeted therapies, and hormonal agents in China and South Korea as well as strategies to circumvent these barriers. In both markets, Roche/Genentech/Chugai’s HER2-targeted monoclonal antibody Herceptin (trastuzumab) has received regulatory approval. GlaxoSmithKline’s small-molecule HER2 inhibitor Tykerb (lapatinib) is available in both markets. HER2 overexpression is a well-validated marker for increased likelihood of response to these premium-priced HER2-targeted agents; however, the use of molecular testing to identify patients who are overexpressing HER2 represents an extra cost to the healthcare systems. As novel HER2-targeted agents such as Roche/Genentech/Chugai’s Kadcyla ado-trastuzumab emtansine [T-DM1]) and Roche/Genentech/Chugai’s Perjeta (pertuzumab) continue to emerge, the financial impact of treating this population is set to put increasing cost pressures on healthcare authorities.

Targeted agents are beginning to penetrate the advanced HR+ population; Novartis’s Afinitor (everolimus) has proven efficacy when used in combination with hormonal therapy in recurrent, postmenopausal patients with advanced disease. It is well established that hormone-receptor-positive (HR+) breast cancer patients respond well to endocrine therapy. In both China and South Korea, the majority of hormonal therapies are now available as generics; however, AstraZeneca’s Faslodex (fulvestrant) remains patent-protected and commands a premium price in both markets. Premium-priced agents directed to the HR+ population are likely to be particularly burdensome to payers because a large proportion of diagnosed breast cancer cases are HR+. Understanding how to best position your brand in these key Asian markets will be essential to maximizing uptake in the region.

Questions Answered in This Report:

  *   Understand the access and reimbursement environment for costly breast cancer brands in China and South Korea. Which breast cancer therapies are reimbursed in these markets? Which agents are included on China’s National Reimbursement Drug List (NRDL) and on South Korea’s positive list for reimbursement? What therapies do physicians and payers expect to be included in the new NRDL? Have any therapies achieved inclusion on Provincial Reimbursement Drug Lists (PRDLs), and if so how frequently are they used? What are the restrictions to reimbursement of formulary-listed drugs? How might reimbursement of key breast cancer therapies change in the near future?

  *   Understand the impact of pricing and reimbursement on the use of currently available breast cancer agents. What do physician prescribing patterns reveal about the impact of payer policy on patient access to drugs? Does access vary among agents? What are the prescribing differences between public and private hospitals? How restrictive are prescribing limitations compared with other market access hurdles? What are the key drivers behind current prescribing trends? How will these change over the next three years? In discount scenarios, how much influence would price discounts on key therapies have on prescribing of these products? Explore physician and payer perspectives on emerging brands: What hurdles will emerging therapies encounter in these markets? How are emerging therapies perceived? How do payers’ attitudes toward emerging agents differ between China and South Korea? How do physicians hope to prescribe emerging agents? How will payer policy impact their uptake? Can companies learn from market access issues facing current manufacturers in these markets? How will market access barriers evolve, and what challenges are companies likely to face in the future? What clinical and commercial factors would most likely convince payers to grant emerging agents coverage or superior positioning? In discount scenarios, how much influence would price discounts on key therapies have on prescribing of these products?


This Emerging Markets Physician & Payer Forum report explores how key market access drivers such as price and payer policy affect prescribing of breast cancer therapies in China and South Korea. Insights from 100 surveyed medical oncologists and 7 interviewed payers who influence reimbursement at a national or regional level will inform insights in this report.

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Mentioned in this report:

  • - Roche
  • - Novartis
  • - Pfizer
  • - Astrazeneca
  • - EddingPharm
  • - GlaxoSmithKline
Decision Resources Group brands include: