U.S. Physician and Payer Forum

August 2013

The Rapidly Evolving Multiple Sclerosis Treatment Landscape: How Are U.S. Physicians and Payers Responding to the Influx of New Disease-Modifying Therapies?

Report Authors
Jonathan W. Searles
Bethany A. Kiernan, Ph.D.

Introduction:

The landscape of disease-modifying therapies (DMTs) for the treatment of multiple sclerosis (MS) has expanded considerably in the last several years, owing to the launches of three oral therapies, namely first-to-market Gilenya (Novartis/Mitsubishi Tanabe Pharma’s fingolimod), Aubagio (Genzyme’s teriflunomide), and, most recently, Tecfidera (Biogen Idec’s dimethyl fumarate [formerly BG-12]). The MS market is poised for further growth with the forecasted launch of at least five additional DMTs over the next three years, including two alternative formulations of existing DMTs—a three-times-weekly (3TW), high-volume version of Copaxone (Teva’s Copaxone 40 mg/mL) and a subcutaneously administered pegylated version of IFN-β-1a (Biogen Idec’s Plegridy)—as well as three novel DMTs, Lemtrada (Genzyme/Bayer HealthCare’s alemtuzumab), daclizumab high yield process (HYP) (Biogen Idec/AbbVie), and ocrelizumab (Roche/Genentech). With an influx of new DMTs and accompanying growth in treatment costs, prescribers’ choice of therapy and payers’ decisions about formulary inclusion/coverage will become increasingly complex as developers strive to differentiate new entrants within the evolving treatment algorithm and to position themselves as favorably as possible on payers’ formularies.

In this report, we surveyed 105 neurologists, and 30 managed care organization (MCO) pharmacy and medical directors to assess their attitudes, expectations, receptivity, and reservations regarding currently marketed and late-stage emerging DMTs for the treatment of MS.

Questions Answered in This Report:

  *   Understand neurologists’ opinions and utilization of currently available MS DMTs. What percentage of surveyed neurologists’ patients across the MS spectrum receive DMT, and what proportion of patients are receiving each DMT? How well managed do neurologists consider patients to be by these therapeutic options? What factors most influence neurologists’ choice of DMT? What are neurologists’ perceptions of reimbursement challenges associated with prescribing MS DMTs? How have physicians incorporated the oral DMTs (Gilenya, Aubagio, Tecfidera) into their practice? What impact have risk stratification tools had on prescribing of Biogen Idec’s Tysabri? What are physicians’ opinions about potential expanded labelings key subpopulations for several current DMTs?

  *   Assess MCO directors’ opinions and approaches on controlling healthcare spend in MS today. What is the current state of formulary coverage of currently available MS DMTs? What types of formulary restrictions do MCOs impose on MS DMTs today, and how extensively are they imposed? What are surveyed MCO directors’ opinions regarding evidence of pharmacoeconomic benefit for MS DMTs, and what types of health economics outcomes data do they find most compelling?

  *   Explore neurologists’ attitudes toward treating MS and payers’ outlooks toward reimbursing MS DMTs in an evolving treatment landscape. How do surveyed neurologists expect to incorporate Copaxone 40 mg/mL 3TW, Plegridy, Lemtrada, daclizumab HYP, and ocrelizumab into clinical practice? Where do they expect each agent to sit in the changing treatment algorithm, and which current DMTs are most at risk of losing share following the launch of each of these emerging therapies? What factors will most influence formulary inclusion of these emerging DMTs? What reimbursement constraints, including tiering and formulary restrictions, do MCO directors expect to impose on these new entrants?

  *   Explore neurologists’ and MCO directors’ receptivity to and expectations for generic versions of the oral DMTs, generic versions of Copaxone, and biosimilar versions of the IFN-β therapies. How do surveyed neurologists expect generic competition to affect their treatment decisions, and what sort of pressure from third-party payers do they anticipate? How do surveyed MCO directors expect to cover generic/biosimilar alternatives, and what impact are such products likely to have on MCOs’ coverage of the originator brands?

Scope:

This U.S. Physician & Payer Forum report contains insights from a survey of 105 neurologists and 30 MCO pharmacy/medical directors regarding physician and payer dynamics that affect prescribing practices for the treatment of MS in the United States. In this report, we explore the use, reception, and formulary status of key current and recently launched MS DMTs by neurologists and MCO directors, and gauge physician and payer outlook on five late-stage emerging DMTs. By understanding the attitudes and expectations of prescribers and payers toward current, recently approved, and emerging MS DMTs, stakeholders can gain an understanding of the complex and changing prescribing and reimbursement climate for MS.

Markets covered: United States.

Primary research: Online survey of 105 neurologists and 30 MCO pharmacy or medical directors.

Epidemiology: 2012, 2017, and 2022 diagnosed prevalent cases of relapsing-remitting MS (RR-MS) and chronic-progressive MS (CP-MS, which encompasses secondary progressive MS [SP-MS] and primary progressive MS [PP-MS]).

Population segments: Where appropriate, our data and analyses are segmented by the following key MS subtypes: clinically isolated syndrome (CIS), RR-MS, SP-MS, and PP-MS.


Search Reports

Mentioned in this report:

  • - AbbVie
  • - Bayer HealthCare
  • - Biogen Idec
  • - EMD Serono
  • - Genentech
  • - Genzyme
  • - Merck Serono
  • - Mitsubishi Tanabe Pharma
  • - Novartis
  • - Roche
  • - Sanofi
  • - Teva
Decision Resources Group brands include: