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

MMIT Reality Check on Growth Hormones (April 2016)

Posted by Matt Breese on Apr 14, 2016

Find me on:

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

Payer Coverage: The following snapshot reveals the difference in payer pharmacy benefit coverage across each channel. Drilling into the "restricted" lives reveals the trends and step therapies and prior authorizations. For payer lives, policies slightly favor multiple product steps over a single step and appropriate PAs over restrictive-to-label PAs.reality-check-gh-april-2016.png

Source: MMIT data as of Q2 2016

Trends:  Recent news related to growth hormone deficiency pharmaceuticals highlights some key trends in this therapeutic area. One trend is the increasing demand for longer acting agents. Key manufacturers invest significant research and development into agents with long-acting and/or sustained release properties. Advancements in the recombinant technology will be critical to the success of these treatments. "Biobetters" receive a lot of buzz within this space and expect to hit the market by 2017. A global report predicts that the market will reach $1.88 billion by 2024 with novel biobetters seizing significant market share over the next decade.

Key Findings: MMIT's pharmacists reveal several key findings when taking a closer look at the market access data for growth hormone deficiency treatments. These include impacts from a dynamic drug pipeline, restricted access and payer reimbursement policies, and product differentiation among channels. Emerging manufacturers rapidly develop novel therapies to compete with more established therapies in the class, most with once-weekly and semi-monthly dosing. Health plans cover products using a variety of strategies with top payers including prior authorization and step therapies to manage appropriate drug therapy. Prior authorizations are much more common than step therapies but both play a role for all products on at least some formularies. Finally, we see the most product differentiation on commercial and exchange formularies but medicare plans are the most restricted. Across all plans, payers identify one or two growth hormone products as the preferred treatments.

In the full Reality Check on growth hormone products 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