And then just how much providers will approve it after Gleevec goes generic is another. Merrill today modeled $400 mil in peak sales in 2016. Barclays recently came out with their opinion and used $1.8 bil. Complete wild card as to what will ultimately become of Ponatinib in the first line.
Between that and 113, it should be an interesting few years to say the least.
I think someone has to demonstrate a positive effect on the "net income available to common shareholders" line item.
Until then, insurance will use the cheapest drug first (and not even that, if they think they can get away with it.)
I doubt it's possible, but if there were some way to offer a tiered pricing schedule, it would do something toward getting Pona into the front line -- if you want to use Pona only after you've tried other crap, then you pay more; if you use Pona from the start, then you pay less.
That would be a break-even life expectancy figure that actuaries could easily calculate, so people who get CML young would get Pona immediately. Those who were older would get Gleevec first.