The multiple sclerosis field has been a hotbed for payers pressing drugmakers to trade formulary spots for discounts. But that’s changed a bit in 2018—and that means some MS-dependent companies can breathe a big sigh of relief.
This year, MS formularies are “less restrictive,” Bernstein analyst Ronny Gal pointed out in a recent note to clients, with just 24% of drugs blocked versus last year’s 42%. And if you compare the 2018 figure to 2016’s peak of 48% of drugs blocked, this year represents an even bigger shift.
The way Gal sees it, there’s now a “recognition by payers that the category is challenging to manage,” and they’ve responded with a “willingness to cover multiple drugs with the same mechanism of action,” he wrote.
The result? More drugs now bear a “preferred” distinction among payers—77% versus 72% last year—and there is “no material advantage among them.” Companies with more than one MS drug have won formulary spots for a second drug, a “portfolio effect” that’s helped players such as Biogen and Novartis.
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Meanwhile, formulary management has yielded some surprises over at Teva, whose 20mg dose of blockbuster Copaxone has gotten the cold shoulder from payers in favor of generic Glatopa from Novartis’ Sandoz. But rather than switching to the generic, 20mg patients are instead switching drugs altogether, Gal noted.
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And on the 40mg Copaxone side, where Teva’s branded therapy and Mylan’s copy have similar coverage, Teva has kept its market share intact. “This seems to reflect some sort of a half-hearted attempt by the PBMs to push for a generic,” Gal said in a video, adding that “a physician preference for the brand given the complexity of the reference drug” and Teva’s patient assistance services are likely also playing a role.