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
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
Explore neurologists’ attitudes toward treating MS and payers’
outlooks toward reimbursing MS DMTs in an evolving treatment landscape.
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
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
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.