MMIT's team analyzes the market access landscape for immune globulin treatments 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 route of administrations reveals that the majority of treatments process under a combination of both pharmacy and medical benefit. However, subcutaneous products have the highest percentage of lives processing exclusively through medical benefit.
Source: MMIT data as of Q2 2016
Trends: Recent news related to IVIG pharmaceuticals highlights some key trends in this therapeutic area. For some time, access to plasma-based treatments caused supply issues for HCPs. The addition of new products, along with more options for administration, results in increased availability. Health systems continue to experiment with new treatments to optimize the use of IVIG to mitigate adverse events. However, HHS reports that, "Sixty-one percent of responding physicians indicated that they had sent patients to hospitals for IVIG treatment because of their inability to acquire adequate amounts of IVIG or problems with Medicare payment." Due to the cost of treatment and supply, some providers cannot afford to infuse patients.
Key Findings: Although IG products can address many patient conditions, the FDA only approves most for a minority of indications, including PID (primary immunodeficiency) and CIDP (chronic inflammatory demyelinating polyneuropathy). Therefore, many provider and pharmacist communities establish a set of guidelines for ethical, off-label use. Payers also reimburse the IG class in a unique manner compared to other highly managed classes. Payers actually implement off-label utilization lists when sufficient scientific research supports their use. Additionally, unlike many other similar classes, medicare coverage is actually less restrictive than commercial and health exchange channels for IG products. On another note, patients have more options than ever to seek alternative treatments. Although not many manufacturers currently offer plasma-based therapeutic areas, pipeline research suggests that additional manufacturers plan on entering the market.
In the full Reality Check on immune globulin (IVIG) 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.