Strategic Insights

December 2013

Trends in Reimbursement for Immune Biologics: Strategies for Success

  • Pages:36
  • Tables:Multiple
  • Figures:Multiple
  • Citations:N/A
  • Drugs:N/A
  • Interviews:N/A

Introduction:

The current biologics/novel oral therapy market for rheumatoid arthritis (RA) and psoriasis—two important immune indications—is crowded, with new agents with similar or new mechanisms of action expected to enter the market starting in 2014. In the United States, biologics/novel oral agents for RA and psoriasis cost $16,500-$32,000 per patient for one year of treatment. The high cost often results in reimbursement hurdles that limit patients’ ability to access these therapies. Payers often impose cost-control measures to limit the use of biologics, including prior authorization and step-therapy requirements.

As more biologics/novel oral agents enter the market, and with the anticipated approval of biosimilar versions of several marketed biologics starting in 2015, we can expect more payer restrictions, especially on the recently launched and new agents. Drug marketers must employ different strategies and find new ways to overcome the increasing barriers.

Questions Answered in This Report:

  *   Sales of biologics/novel oral therapies for RA and psoriasis totaled $ 9.5 billion in 2012 and are expected to continue to grow at a 4% annual rate in the next ten years, reaching $14.5 billion by 2022. Which biological agents dominate the RA and psoriasis market, and which are the agents more often used as follow-on therapies?

  *   In an attempt to limit the increasing costs associated with biologics/novel oral therapies, payers often use a range of strategies and tactics. What are the cost-control measures imposed by payers on physicians and patients to limit the use of biologics/novel oral therapies?

  *   As new biologics/novel oral agents and biosimilars enter the market, drug marketers can expect more payer scrutiny and restrictions, especially on recently launched agents. What strategies must drug marketers employ in order to obtain favorable market access for emerging biologics/novel oral therapies?

Scope:

Markets covered: United States.

Primary research:

- Interviewed experts: Leading U.S. rheumatologists and dermatologists.

- Surveyed experts: Medical directors, U.S. health plan, >100,000 lives; Pharmacy directors, U.S. health plan, >100,000 lives. U.S. rheumatologists (Northeast, South, Midwest, West) treating RA patients (Medicare and non-Medicare beneficiaries). U.S. dermatologists (Northeast, South, Midwest, West) treating psoriasis patients (Medicare and non-Medicare beneficiaries).


Search Reports

Mentioned in this report:

  • - AbbVie
  • - Amgen
  • - Biogen Idec
  • - BioVitrum
  • - Bristol-Myers Squibb
  • - Celgene
  • - Eli Lilly
  • - Genentech/Roche
  • - GlaxoSmithKline
  • - Incyte
  • - Janssen Biotech
  • - Merck & Co.
  • - Novartis
  • - Pfizer
  • - Regeneron
  • - Sanofi
  • - Stiefel
  • - UCB
  • - Vertex Pharmaceuticals
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