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MMIT Reality Check on Hemophilia (March 2016)

Posted by Matt Breese on Mar 10, 2016

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MMIT's team analyzes the market access landscape for Hemophilia treatments in our most recent Reality Check. The following brief highlights some of our key takeaways from the piece.

Payer Coverage: A review of the average pharmacy benefit market access for Hemophilia A and B drugs reveals slight differences among factors. Hemophilia A treatments are slightly less restricted than Hemophilia B but, overall, roughly 3/10 of U.S. payer-controlled lives are restricted by PA or step therapy policies and another 3/10 are not covered entirely.

reality-check-hemophilia-v2.pngSource: MMIT data as of Q1 2016

Trends: Looking to Hemophilia news and updates, several trends are apparent. Due to the high cost of treatment for Hemophilia patients, an increasing number of payers leverage large specialty chain pharmacies to streamline reimbursement. Both manufacturers and health plans in the space develop relationships with these pharmacies to ensure that treatment is provided to patients in the most efficient way possible. A recent article from the New York Times describes how more Hemophilia patients work in the pharmaceutical industry than every before. Manufacturers and pharmacies leverage patients to sell products or lead patient support programs. There are clear benefits in leveraging these individuals to find common ground with other patients but some question whether this could result in a conflict of interest.

Key Findings: MMIT's key findings in the Hemophilia market landscape include restricted payer reimbursement, streamlined policy standardization and innovative therapeutic development. A significant percentage of top payers implement utilization management approaches to control costs and manage physician prescribing. While roughly one-third of total lives require a prior authorization, most policies are appropriate to their FDA-approved label. Typical policies will read as broad coverage for specific indications, with minimal management of specific Hemophilia products. However, some plans do distinguish the Recombinant products based on label, original, half-life, etc. The Hemophilia landscape quickly evolves with pipeline products gaining speed and approvals on the horizon. The anticipated approvals gain increasing attention with their potential therapeutic advantages that may lead to better product placement.

In the full Reality Check on Hemophilia below, MMIT's team of experts takes a deeper look into the clinical characteristics, drug market access, payer coverage and summarizes key findings within Hemophilia.

 View Reality Check

Topics: Market Access