U.S. Physician and Payer Forum

November 2013

Will the Anticipated Approval and Reimbursement of Novel Orals Result in a Major Shift in Biologics Prescribing in Psoriasis?

Report Authors
Eun-Jin Yang, Ph.D.
  • Pages:147
  • Tables:21
  • Figures:126
  • Citations:N/A
  • Drugs:13
  • Interviews:N/A

Introduction:

Psoriasis is a chronic inflammatory skin disorder that, despite its non-life-threatening nature, has a major impact on patients’ quality of life. The growing use of biologics and increasing rates of drug treatment in moderate to severe psoriasis have resulted in a psoriasis market with multi-billion-dollar sales. The current landscape of the moderate to severe psoriasis market has been characterized by intense competition between the two tumor necrosis factor-alpha (TNF-α) inhibitors (Amgen/Stiefel/Pfizer’s Enbrel [etanercept] and AbbVie’s Humira [adalimumab]) as first-line biologics and the growing challenge of Janssen Biotech’s interleukin-12 and 23 (IL-12/23) inhibitor Stelara (ustekinumab) against TNF-α inhibitors’ entrenched dominance in the moderate to severe psoriasis market. Further intensifying the competition for patient share, several new agents are poised to enter the psoriasis market within the next two years, including two agents with the advantage of oral formulations (Pfizer’s Janus kinase (Jak) inhibitor Xeljanz [tofacitinib] and Celgene’s phosphodiesterase-4 [PDE-4] inhibitor apremilast), and efficacious IL-17 inhibitors (Novartis’s secukinumab and Eli Lilly’s ixekizumab). The expanding use of these premium-priced agents will likely strain healthcare budgets, and increasing payer restrictions on accessing prescription psoriasis drugs are expected.

Questions Answered in This Report:

  *   Current perceptions and treatment trends in moderate to severe psoriasis: What percentage of moderate to severe patients are treated with each biologic among the TNF-α inhibitors and Stelara? What percentages of patients treated with each psoriasis biologic experience an inadequate response or discontinue because of drug intolerance or adverse events? What are the most common treatment histories of patients who start on biologics and Stelara? What have been the main constraints on the adoption of Stelara as a first-line biologic? How much do surveyed dermatologists expect to prescribe Stelara as a first-line biologic by year-end 2015? How does the FDA’s approval of self-administration for Stelara influence dermatologists’ prescribing behavior? What cost-control measures do physicians and psoriasis patients most frequently encounter for each biologic? How do differences in reimbursement restrictions on biologics influence dermatologists’ prescribing of biologics?

  *   Dermatologist perspective on emerging agents and their impact on prescribing of biologics: What is the expected uptake of emerging oral and biological agents among surveyed dermatologists at year-end 2015? In which lines of therapy are patients most likely to receive Xeljanz and apremilast if these agents are placed on a preferred versus a nonpreferred tier? Which factors do surveyed dermatologists think will most constrain their prescribing of Xeljanz and apremilast? How do surveyed dermatologists expect their prescribing of biologics to change over the next three years, particularly given the expected launch of lower-priced oral therapies? In which treatment lines do surveyed dermatologists expect to prescribe Novartis’s IL-17 inhibitor secukinumab and Eli Lilly’s IL-17 inhibitor ixekizumab if these agents are placed on a preferred versus a nonpreferred tier? What factors do they think will most constrain their prescribing of IL-17 inhibitors?

  *   Payer perspective on emerging agents and reimbursement dynamics in the US: What are the current tier positions of biologics in commercial plans and Medicare PDPs and what are the reasons behind the tier placement of each biologic? What are the most commonly utilized cost controls and step therapy requirements for biologics? How is Xeljanz currently positioned on payers’ formularies, and what is the drug’s anticipated tier positioning following approval for psoriasis? What clinical and commercial factors would be most likely to persuade payers to grant novel oral and biological agents advantaged tier positioning? In which pricing scenarios would Xeljanz and apremilast be best positioned to challenge the TNF-α inhibitors in terms of formulary positioning? What restrictions do payers expect to institute for Xeljanz and apremilast in the treatment of psoriasis? Do the launches of these agents have the potential to alter step therapy requirements imposed on biologics? What will be the likely tier positioning and cost controls for the IL-17 inhibitors?

Scope:

Decision Resources’ Physician & Payer Forum report “Will the Anticipated Approval and Reimbursement of Novel Orals Result in a Major Shift in Biologics Prescribing in Psoriasis? U.S. Payer and Prescriber Attitudes Toward Novel Oral and Biologic Emerging Agents in the Psoriasis Market” explores the factors that shape current and future treatment patterns as well as reimbursement trends in psoriasis. Additionally, this report reveals dermatologist and payer perception of oral and biological therapies with a novel mechanism of action (MOA), which are expected to launch within two years, as well as biosimilar versions of infliximab and their impact on current therapy use. This report is based on a survey of 106 dermatologists and 31 pharmacy and medical directors (PDs and MDs) of managed care organizations (MCOs) that offer commercial health insurance and Medicare prescription drug plans.

Markets covered: United States.

Primary research: Online survey of 106 dermatologists and 31 MCO pharmacy or medical directors.

Epidemiology: 2012-2016 prevalent cases of psoriasis in the United States.

Market analysis: 2012 U.S. market and patient share by drug class.


Search Reports

Mentioned in this report:

  • - AbbVie
  • - Amgen
  • - AstraZeneca
  • - Celgene
  • - Eli Lilly
  • - Janssen
  • - Merck
  • - Novartis
  • - Pfizer
  • - Stiefel
Decision Resources Group brands include: