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MMIT Reality Check on PCSK9 Inhibitors (April 2016)

Posted by Matt Breese on Apr 28, 2016

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MMIT's team analyzes the market access landscape for PCSK9 inhibitors 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 the relatively new PCSK9 class of treatments shows the variation in coverage across channels. Medicare formularies are the most restrictive with nearly half of lives restricted by a PA or step therapy policy and the remaining half are not covered on formularies entirely.reality-check-pcsk9-april.png

Source: MMIT data as of Q2 2016

Trends:  Recent news related to PCSK9 pharmaceuticals highlights some key trends in this therapeutic area. While specialty drug spend doubled over the past few years, the surprisingly meager launch sales of the two PCSK9 products could reveal signs that payers found a way to combat rising drug prices of these types of products. Onlookers believe that the restricted reimbursement established by plans and PBMs translates directly to the less-than-stellar sales of these products thus far. Praluent and Repatha showcase extremely similar clinical results so the companies are looking to different avenues to gain the competitive edge. Both products won extremely valuable deals with the nation's largest PBMs early on.

Key Findings: MMIT's pharmacists reveal several key findings when taking a closer look at the market access data for PCSK9 inhibitors. Outside of the early PBM deals with enormous lives-controllers, manufacturer contracting with payers proves difficult with the prevalence of cost-control strategies that block access. As expected, Medicare formularies feature more restrictive access for patients while commercial and managed medicaid formularies relax access in a greater percentage of geographic regions. The unique environment in the market incites more creative payer utilization management approaches. When prior authorizations do exist for pharmacy benefit lives, the majority (around three-quarters) are restrictive to label. Developing injectable agents in the pipeline could result in a more dynamic market access landscape upon entry. Industry experts expect bococizumab to be the first to join the existing two products on the market.

In the full Reality Check on PCSK9 inhibitors 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