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MMIT Reality Check on Narcotic Pain (April 2016)

Posted by Matt Breese on Apr 7, 2016

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

Payer Coverage: Narcotic pain treatments are heavily restricted by payer pharmacy benefit lives. While Medicare Part D formularies are the most restrictive, commercial and health exchange formularies implement stricter prior authorization policies.reality-check-pain-narcotic.png

Source: MMIT data as of Q2 2016

Trends:  Pharmaceutical manufacturers offer chronic pain patients an increasingly diverse range of pain relief and treatments with extended release capabilities. Late-phase pipeline agents join the handful of pain management treatments already on the market to deliver a path to pain relief without the use of additional rescue medications. However, pharma companies in this space face a variety of threats when it comes to physician prescribing. One of the biggest challenges is increasingly restrictive guidelines, offered up by organizations like the CDC as a result of the painkiller abuse epidemic, to limit prescribing of opioid treatments.

Key Findings: MMIT's pharmacists reveal several key findings when taking a closer look at the market access data for narcotic pain. These include restricted payer reimbursement, the adoption of abuse-deterrent treatments and generic/alternative influence. Across nearly all geographic areas, narcotic medications and pain treatments face heavily restricted payer coverage. When prior authorizations or step therapies eaxist, a significant percentage of top payers implement restrictive prior authorization or step therapy policies to control costs and manage physician prescribing. While older-generation brands and generic medications do not include abuse-deterrent properties, manufacturers prioritize the development of abuse-deterring drugs, aligning to recent FDA guidance. Generic prevalence creates a more complex landscape, as many branded products must step through one or more generic medications. As an example, two-thirds of health exchange formularies that implement step therapies require a product to step through two or more products.

In the full Reality Check on narcotic pain 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.

View Reality Check

Topics: Market Access