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MMIT Reality Check on Hepatitis C (May 2016)

Posted by Matt Breese on May 13, 2016

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MMIT's team analyzes the market access landscape for Hepatitis C pharmaceuticals in our most recent Reality Check. The following brief highlights some of our key takeaways from the piece.

Payer Coverage: A market access breakdown by channel reveals that medicare formularies feature the greatest product differentiation while commercial and exchange formularies have a much more event split between covered and preferred designation for drugs. Top payers implement unique utilization management techniques for the breakthrough medications, Harvoni, Sovaldi, Viekira and Zepatier. reality-check-hepatitis-c-may.png

Source: MMIT data as of Q2 2016

Trends: Recent news related to Hepatitis C cures/treatments highlights some key trends in this therapeutic area. Given the cost of the existing drugs on the market, some private and public insurers refuse to cover the treatment(s) today. Some payers will only cover medications for the sickest patients, resulting in the rationed care, according to an analysis by Jack Bilson. According to the CDC, baby boomers are 5x more likely to have HCV, which continues to generate significant social implications. Additionally, researchers conclude that only one in two people with HCV are unaware that they have the virus. The CDC currently invests heavily in promoting Hepatitis screening.

Key Findings: A review of the past 18 months demonstrates the power of effective manufacturer contracting with payers in the Hep C market. Prior to arrangements between Express Scripts and Abbvie as well as CVS Health and Gilead, many payer policies limited access to newer, costlier agents to patients with advanced stage cirrhosis. The introduction of "cures" into the market generates a new dynamic for preferred market access. The newer products in the space saw a steep increase in advantaged access after launch while existing treatments' access declined. Hepatitis C manufacturers continue expanding the scope of treatments available to the consumer. With the recent approval of Zepatier, one major pipeline moves in-market, with others on its heels. The deal between J&J and Achillion provides momentum for ACH-3102, which could challenge Gilead's treatment length. 

In the full Reality Check on Hepatitis C 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