MMIT's team analyzes the market access landscape for ED treatments in our most recent Reality Check. The following brief highlights some of our key takeaways from the piece.
Payer Coverage: Market access for erectile dysfunction treatments reveals a significant amount of restricted reimbursement overall, accentuated by the lack of coverage in the Medicare Part D and Medicaid channels. Utilization management from overall payer pharmacy benefit lives reveals key trends in step therapy and PA policies.
Source: MMIT data as of Q1 2016
Trends: Recent media from healthcare influencers reveals a couple of major trends in the sexual health/ED market. A review of existing clinical trials shows that the majority of testing involves existing in-market drugs. Most of the industry focuses on how ED drugs impact patients that also suffer from another condition, such as diabetes or hypertension, according to Forbes. Additionally, many key pharma players pay increasing attention to patent legislation to extend their product's lifecycle. A recent article from Mondaq describes that recent developments in guidelines are specifically relevant to therapeutic areas like ED, where some entrenched products began their lives indicated elsewhere.
Key Findings: Major themes in the ED pharmaceutical arena include restricted reimbursement, coverage variation across channels and a challenging promotional landscape. A significant percentage of top payers implement utilization management to control cost and manage physician prescribing, with nearly three-quarters of lives facing barriers to coverage, whether in the form of utilization management policies or not-covered statuses. As expected from drugs grouped together as "lifestyle" treatments, Medicare Part D and Medicaid restrict access to ED treatments almost entirely in most geographies. Commercial formularies are the least restrictive but still restrict more than half of lives. While some entrenched products maintain preferred status with major health plans, each product is advantaged in some geographies. Unlike many other therapeutic classes, many companies continue to find success with more traditional promotional strategies, although recent regulations offer greater challenges for these campaigns.
In the full Reality Check on ED below, MMIT's team of experts takes a deeper look into the clinical characteristics, drug market access and payer coverage to summarize key findings within the class.