MMIT's team analyzes the market access landscape for hereditary angioedema treatments in our most recent Reality Check. The following brief highlights some of our key takeaways from the piece.
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. Medicare formularies are the most restrictive, while the commercial landscape is significantly looser with reimbursement than other channels.
Source: MMIT data as of Q2 2016
Trends: Recent news related to HAE treatments highlights some key trends in this therapeutic area. A handful of hereditary angioedema launches reveals the shift in drug development from manufacturers. Novel therapies incite increased prophylaxis utilization. One example of how M&A activity is shifting development is Shire's acquisition of Dyax and their phase 3 HAE treatment. 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 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.