MMIT's team analyzes the market access landscape for asthma/COPD treatments in our most recent Reality Check. The following brief highlights some of our key takeaways from the piece.
Payer Coverage: Payers implement a variety of reimbursement restrictions for respiratory products. Roughly 10% of lives are restricted by step therapies (mostly in the form of single steps), with slightly more restricted by prior authorizations (a nearly even split between restrictive and appropriate policies).
Source: MMIT data as of Q2 2016
Trends: Recent news related to asthma and COPD treatments highlights some key trends in this therapeutic area. Organizations, like the COPD foundation, find recent success in programs intended to educate patients and providers on respiratory treatments, which enables patient groups to influence the value and coverage debate. Another trend is pharma's ability to influence prescribing via clinical research data. Finally, a recent report highlights some key prescribing constraints that HCPs face at the point of care. Market barriers include pricing, reimbursement restrictions, guidelines and patient preferences.
Key Findings: The prevalence of prior authorizations and step therapies create a complex market access landscape for the respiratory market basket. Over the past 6 months, the percentage of restrictive prior authorizations, for example has increased roughly 10% for certain product groupings in the respiratory treatment area. Novel therapies, targeting components of the anti-inflammatory pathway, will likely have well-defined roles in asthma treatment and management. Respiratory treatments pivot to include day-to-day symptom control and quality of life in addition to severe case management. From a segmentation perspective, product delivery greatly influences direct competition within the respiratory market basket.
In the full Reality Check on asthma/COPD 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.