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MMIT Reality Check on Testosterone

Posted by Matt Breese on Feb 18, 2016

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Touching a network across healthcare in pharma, payer and provider, MMIT's team extracts market access insights for testosterone drugs in our most recent Reality Check. The following brief highlights some of our key takeaways from the piece.

Payer Coverage: Market access for testosterone products reveals significant restrictions for payer-controlled U.S. lives. Formularies representing 3/4 of overall pharmacy benefit lives do not cover treatments or restrict reimbursement with prior authorizations or step therapies.

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Source: MMIT data as of Q1 2016

Trends: Current news around "low T" marketing and increasing attention to clinical efficacy dominates the testosterone landscape. Some of the most successful pharma marketing campaigns exist in this therapeutic area but industry experts question whether the drug marketing overpowers the supporting science, according to Science-Based Medicine. Clinicians adjust their efficacy metrics for testosterone drugs as a result of recent scrutiny of sexual function scoring with one manufacturer sponsoring a recent study evaluating benchmarks in the space.

Key Findings: Major themes in the testosterone pharmaceutical arena include restricted reimbursement, medical benefit complexity and opportunistic promotion. A significant percentage of top payers implement utilization management to control cost and manage physician prescribing, with 75% of lives facing barriers to coverage. Several testosterone treatments also process under medical benefit for payer-controlled lives, with half of those lives restricted by a PA or step therapy policy. A comparison of treatments in this space reveals several key players with a much higher percentage of preferred formulary status. However, at a regional or plan level, all product have advantaged market access on some formularies, creating promotional opportunities for all manufacturers.

In the full Reality Check on branded testosterone 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