The Current Reimbursement Environment Creates a Significant Barrier for Agents Targeting the TNF-Refractory Population, According to a New Report from Decision Resources
BURLINGTON, Mass., Dec. 1, 2010 /PRNewswire/ -- Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that although Amgen/Pfizer/Stiefel's Enbrel will remain the most-prescribed first-line biologic for moderate-to-severe psoriasis, it will lose market share at this line of therapy to agents in the IL-12/IL-23 inhibitors drug class, namely Centocor Ortho Biotech/Janssen-Cilag's Stelara. Surveyed U.S. dermatologists estimate that among moderate-to-severe psoriasis patients who currently initiate biologic therapy, approximately half receive Enbrel and more than one-third receive Abbott/Eisai's Humira.
The new U.S. Physician & Payer Forum report entitled Stelara and Briakinumab in Psoriasis: Do Payers and Dermatologists Foresee a Dramatic Shift in Psoriasis Treatment and Drug Coverage? finds that the continued uptake of Stelara and—to a lesser extent—the anticipated launch of Abbott's briakinumab in 2011, will have a greater impact on the first-line biologic share of Enbrel than on Humira. Although the majority of patients who initiate biologics have been previously treated with conventional oral drugs, over one-third of those receiving Enbrel or Humira (both TNF-alpha inhibitors) as first-line biologics are naive to conventional oral agents. While the number of surveyed dermatologists prescribing the TNF-alpha inhibitor Remicade (Centocor Ortho Biotech/Merck/Mitsubishi Tanabe) or Stelara as a first-line biologic is similar, a higher percentage of patients receiving Stelara (29 percent) than Remicade (16 percent) in this setting are naive to conventional oral agents.
The report also finds that surveyed dermatologists estimate that more than 40 percent of their psoriasis patients treated with a biologic rely on co-pay assistance programs to afford the drug.
"Despite the benefits of patient assistance programs regarding access to biologics and compliance, only a quarter of surveyed dermatologists believe that awareness of such programs among patients is high, and less than half state that selection of biologics is influenced by how different co-pay programs compare to each other," said Decision Resources Analyst Irene Koulinska, M.D.
According to the report, the current reimbursement environment creates a significant barrier for agents targeting the TNF-refractory population. Currently, 45 percent of surveyed managed care organizations' (MCO) pharmacy directors require failure of TNF-alpha inhibitors before authorizing Stelara. By the end of 2011, the percentage of MCOs likely to authorize Stelara in patients failing one or two TNF-alpha inhibitors will be 60 percent and almost one-fifth of surveyed MCOs anticipate they will reimburse Stelara only after three TNF-alpha inhibitors have failed.
"Among marketed biologics, Stelara is the most likely to be non-preferred or excluded in both commercial and Medicare plans over the next year, mostly due to its high cost and the requirement for administration by a physician," Dr. Koulinska said.
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SOURCE Decision Resources