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MMIT Reality Check on HIV (May 2016)

Posted by Matt Breese on May 20, 2016

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

Payer Coverage: A market access review of HIV treatments reveals slight differences among the major inhibitors. Prior authorization and step therapy policies are both uncommon across these categories, with integrase inhibitors having only 2% more PAs (or a total of 12% of covered lives) than protease inhibitors, for example. On average, payers restrict products with a step edit for a negligible <1% of pharmacy benefit lives.reality-check-hiv-may.png

Source: MMIT data as of Q2 2016

Trends: Recent news related to HIV treatments highlights some key trends in this therapeutic area. A BCBSA study reveals that specialty pharmaceutical drug spend increased by an average of $87 per member in a single year. $8 of this is attributed to HIV product spend, which motivates many payers to demand more drug pricing transparency for categories like HIV. HIV awareness and prevention recently gained momentum from the "celebrity effect". CNN uses the Charlie Sheen case study as evidence of this at work. When he revealed his HIV-positive status, search engines were infused with nearly 3 million more "HIV" searches than normal.

Key Findings: Lack of utilization management for HIV/AIDS medicines results in greater access for patients. Unique to other specialty pharmaceutical classes, PA or step therapy policies are rare, aside from slightly more restrictions for health exchange formularies. Dozens of treatments crowd the landscape, although the five core groupings help to segment out the market. Since the 1990, the FDA approved at least 1 new antiretroviral drug each year. "Booster" drugs, fixed dose combinations and a new "maturation inhibitor" adjust the market access landscape as they arrive on the market.

In the full Reality Check on HIV 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