MMIT's team analyzes the market access landscape for viscosupplement treatments in our most recent Reality Check. The following brief highlights some of our key takeaways from the piece.
Payer Coverage: Payers restrict access to viscosupplements for a great percentage of U.S. lives. A review of coverage shows the complex mix of pharmacy and medical benefit. Additionally, a look into access across channels shows that Medicaid formularies cover the greatest percentage of lives as compared to commercial and health exchange plans.
Source: MMIT data as of Q2 2016
Trends: Recent news related to viscosupplement treatments highlights some key trends in this therapeutic area. Specifically in the United States, the viscosupplement pharmaceutical landscape expands rapidly due to the awareness of these treatments as well as the general acceptance of a more costly, but stabilized treatment plan. Contrary to the lack of support from organizations like the American Academy of Orthopaedic Surgeons, the majority of physicians favor the utilization of viscosupplementation to relieve pain for patients. Recent clinical trials provide evidence for more effective long-term viscosupplement treatments in patients with osteoarthritis of the knee.
Key Findings: The unique combination of pharmacy and medical benefit coverage drives increasing market access complexity in the viscosupplement market basket. Top payers cover viscosupplements for less than half of pharmacy benefit lives. While the medical benefit landscape contains more favorable statuses, many payers and PBMs implement utilization management policies often. Successful pharmaceutical manufacturers focus on penetrating new markets through the investment in payer contracting to achieve less restrictive reimbursement restriction policies. Several treatment options exist for patients with osteoarthritis of the knee. Viscosupplements compete with agents within the immediate class, as well as surgery options and other alternative therapies, based on the patient's situation.
In the full Reality Check on viscosupplements 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.