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

MMIT Reality Check on Multiple Sclerosis (March 2016)

Posted by Matt Breese on Mar 24, 2016

Find me on:

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

Payer Coverage: A deeper look at payer restrictions demonstrates the prevalence of utilization management across pharmacy benefit lives. Prior authorizations are restrictive-to-label for nearly half of lives while step therapy policies require a multiple product step for over one-third of lives.


Source: MMIT data as of Q1 2016

Trends: Recent multiple sclerosis news reveals some key trends within the market basket. A recent example, where a hedge fund investor was granted the ability to conduct a review of the Tecfidera patent, reveals just how critical it is to have solid patent protection in the MS landscape. With billions of dollars in play within a highly competitive landscape, manufacturers invest heavily in defending their products. A flood of clinical development in the MS arena catches the attention of industry stakeholders. MS Discovery points out that there are roughly 100 agents in some stage of investigation for use in treatment for MS patients.

Key Findings: MMIT's key findings within the MS landscape include complex reimbursement, shifting market access and positive clinical developments. Several treatments in the near-term pipeline will emerge over the coming years, which will affect overall MS market access. The generic version of Copaxone provides strong incentives for pharmacies and payers to adopt the new treatment. Using effective payer contracting strategies, brand teams can overcome the increasing price competition in the landscape. Finally, with the exception of Tysabri and Lemtrada, most brands process exclusively through pharmacy benefit. However, reimbursement restrictions, predominantly in the form of prior authorizations and step therapies drive competition across all channels and geographies.

In the full Reality Check on Multiple Sclerosis 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 MS.

 View Reality Check

Topics: Market Access, Branding & Marketing