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MMIT Reality Check on Immunology (March 2016)

Posted by Matt Breese on Mar 17, 2016

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MMIT's team analyzes the market access landscape for immunology 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 products indicated for rheumatoid arthritis treatment reveals how common prior authorizations and step therapies are in the immunology landscape. For top formularies, nearly 2/3 of covered lives require a step therapy while almost 3/4 of covered lives require a PA.


Source: MMIT data as of Q1 2016

Trends: Recent clinical immunology research and news reveals some key trends within the market basket. Rising specialty drug costs in areas like rheumatoid arthritis drives most of the 5.2% increase in overall employer drug spend, according to recent data from Express Scripts. The opportunity for biosimilars in this class is marked as the beginning of a new era by The Motely Fool. On the heels of the Affordable Care Act, Novartis targets Amgen's Enbrel with its 2nd biosimilar application. Medscape also calls out the drug development within Disease Modifying Agents. Several key pharma players infuse R&D into JAK inhibitors and oral biologics.

Key Findings: MMIT's key findings within the immunology landscape include evolving reimbursement support, massive biosimilar implications and critical payer contracting. As JAK inhibitors, several anti-interleukins and the newer PDE4 inhibitors enter the market, the definition of this market basket is quickly evolving. The influx of biosimilars demands greater attention from manufacturers, with many investing in better understanding how pending auto substitution legislation will affect prescribing at the state level. Finally, products launching into this market are tasked with developing strategies that consider the two strongholds in DMARDs, Humira and Enbrel as it's common to see one or both in a preferred position on many formularies.

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

View Reality Check

Topics: Market Access