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MMIT Reality Check on Hereditary Angioedema

Posted by Matt Breese on Dec 31, 2015

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Key insights and data direct from health plans reveals the following market access analysis of HAE treatments in our most recent Reality Check. For the full piece piece, click here.

Payer Coverage: Payers cover HAE products under a combination of pharmacy and medical benefit. Top plans implement a variety of reimbursement restrictions with prior authorizations prevalent across the country.

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Source: MMIT data as of Q4 2015

Trends: A handful of Hereditary Angioedema launches reveals the shift in drug development from manufacturers. Mesdcape identifies the various treatments available in the market, pointing out some of the novel agents arriving on the market. The HAE class garners attention from PBMs, like Prime Therapeutics, as certain drug costs tripled over the past two years.

Key Findings: The unique combination of pharmacy and medical benefit coverage drives increasing market access complexity in the HAE market basket. Over one-quarter of U.S. lives process through both pharmacy and medical benefit. Pharmaceutical manufacturer M&A activity also adds to the complexity of market, creating an even more competitive landscape. Innovative pipeline treatments, ranging from those focused on acute attacks to novel prophylactic agents, will reflect significant shifts in drug market share and overall coverage.

In the full Reality Check on Hereditary Angioedema treatments 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.

View Reality Check

Topics: Market Access