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MMIT Reality Check on IBS Treatments

Posted by Matt Breese on Mar 4, 2016

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

Payer Coverage: Market access for branded IBS treatments reveals the substantial percentage of restricted lives. Formularies representing roughly 52% of payer-controlled U.S. pharmacy benefit lives either do not cover IBS products or restrict reimbursement with prior authorizations or step therapies.


Source: MMIT data as of Q1 2016

Trends: Recent studies reveal the increasing willingness for manufacturers, physicians and patients to work together and more openly discuss irritable bowel syndrome. Metrics from these studies reveal how impactful the disease can be on patients' normal daily activity. While there are only a handful of treatments indicated specifically for IBS-C or IBS-D, the larger gastrointestinal landscape inflates with new drug developments. This could result in drastic shifts in product market share and coverage over the next few years.

Key Findings: Major themes in the IBS pharmaceutical arena include restricted utilization management with complex market access coverage, as well as increasing product development. Many top payers and PBMs implement utilization management approaches to control cost and manage physician prescribing. Restrictions, such as prior authorizations and/or step therapies exist for roughly 40% of payer pharmacy benefit lives. Products in this space face a diverse coverage landscape across geographies and lines of business. A review of Part D plan sponsors reveals that Medicare formularies are less restrictive than commercial formularies on average, with more IBS treatments listed as preferred. Another driver that could result in shifting market access is the unique drug development within the landscape. Drug pipelines reveal that a handful of key manufacturers test alternative products for IBS that are primarily utilized in other therapeutic areas or approved outside of the U.S. 

In the full Reality Check on IBS 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