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

MMIT Reality Check on Hemophilia

Posted by Matt Breese on Oct 8, 2015

Find me on:

With a network across healthcare in pharma, payer and provider, MMIT's team of experts takes a closer look at the Hemophilia market basket in our most recent Reality Check. The following highlights some of our key takeaways from the piece, which can be viewed below.

Payer Coverage: Drilling into the data, only 5 out of the top 10 payers have PA or Medical policies established within the Hemophilia market basket. However, when looking at the entire ecosystem, roughly 70% of U.S. lives have medical benefit coverage.

reality-check-hemophilia.pngSource: MMIT data as of Q4 2015

Trends: Looking to Hemophilia news, a couple key trends are clear. A recent Fortune article points out that increasing benefits come with increasing costs for Hemophilia treatment. The piece highlights Hemophilia's average price increase of 17.6% over the past few years. Although this marks a significant rise in the cost of treatment for Hemophilia, other classes' growth dwarfs Hemophilia. Another theme in this market basket is the concept of more flexible formulary management strategies to accommodate novel and critical therapies, as the Express Scripts Lab addresses.

Key Findings: MMIT's pharmacists reveal several key findings when taking a closer look at the data for the Hemophilia market basket. The current environment exhibits a comparative lack of payer coverage as many payers do not publish a policy for the coverage of Factor products. Those who do cover Factor products restrict access based on diagnosis, specialist prescribing, dosing units and frequency. When it comes to the current lack of differentiation in current market access, increasing market share of long-acting formulations, like FC Fusion Protein products, is expected to create more situations where product advantage is evident.

In the full Reality Check on Hemophilia below, MMIT's team of experts takes a deeper look into the clinical characteristics, drug market access, payer coverage and summarizes key findings within Hemophilia.

 View Reality Check


Topics: Market Access