Formulary guidance and transparency from P&T to point of care

MMIT Reality Check on Dermatology: Acne (July 2016)

Posted by Matt Breese on Jul 5, 2016

Find me on:

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

Payer Coverage: A review of market access for dermatology acne treatments reveals some differences in coverage across each major channel. Commercial formularies are the least restrictive by far, while around seven-eights of Medicare Part D lives are restricted or not covered.


Source: MMIT data as of Q3 2016

Trends: Recent news highlights some key trends in the dermatology-acne landscape. Big data makes its first major debut in the space as highlighted by a recent article from Bloomberg. OptumRx recently increased the amount of restrictions (specifically, the nature of step therapies for branded acne treatments) after seeing a spike in acne spend under their UnitedHealth plans. Additionally, branded dermatological brands face a high degree of generic competition. One major generic player, the Australian-based Mayne Pharma, recently penetrated the U.S. marketing after taking over several dozen brands from Teva and Allergan. They are also known for their acne brand, Doryx.

Key Findings: MMIT's key findings in the dermatology-acne market landscape include an increased focus on omni-channel promotional strategies, increasingly complex PA policy reimbursement techniques from payers and market access differences among coverage channels. The prevalence of prior authorization and step therapy requirements creates challenges for treatments. An incredible 88% of prior authorization policies from top payers are restrictive-to-label. While commercial formularies feature a significant percentage of preferred lives and managed medicaid covers acne products for roughly 94% of lives, Medicare Part D coverage is the most restrictive with only 30% of lives covered. To overcome access challenges, both from payer formularies and from physical interactions with doctors, manufacturers implement more innovative promo strategies, such as non-personal promotion.

In the full Reality Check on acne treatments 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: Specialty, Market Access, Payer, Branding & Marketing