Newer psoriasis drugs top the old, but it's not efficacy that counts. It's payer negotiations: analyst

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Payers are holding down access to new psoriasis therapies delivering incremental benefits, Barclays analyst Geoff Meacham says. (

With this weekend’s American Academy of Dermatology meeting officially all wrapped up, one thing is clear: On the whole, psoriasis treatments are getting more effective. But that doesn’t mean patients have easy access to a new-and-improved crop of meds.

As Barclays analyst Geoff Meacham wrote to clients Tuesday, a score of PASI100 on the Psoriasis Area and Severity Index—in other words, clear skin—may be becoming the “new efficacy bar” for drugs treating the skin disease.

While PASI90 to PASI100 may not necessarily sound like a big jump, “most physicians we spoke with believe that 100% clearance is ideal and there is a meaningful clinical benefit when this is achieved,” he wrote, adding in a separate note that “physicians are very aware of the minute differences between drugs, holding them to very high standards.”

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But convincing payers of that added benefit is another story. Meacham and his fellow analysts at Barclays “continue to see this market driven by payer contracting, placing less emphasis on PASI90 or 100 rates"—in other words, efficacy—"and more on the ability of a manufacturer to negotiate,” he said, adding that most docs he and his team spoke with “continue to complain about access issues for newer drugs in psoriasis, despite impressive efficacy and safety profiles.”

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The psoriasis field has grown increasingly crowded over the last few years, thanks to a slew of biologic approvals. Novartis’ Cosentyx kicked off the party back in early 2015, only to be followed by Eli Lilly’s Taltz, Valeant’s Siliq and Johnson & Johnson’s Tremfya. And therapy areas that see waves of pricey new products tend to be the ones payers target to keep costs down.

And to make matters more challenging for drugmakers trying to improve access, more new treatments are on the way. Over the weekend, AbbVie padded its case for candidate risankizumab with data showing it could beat out J&J’s Stelara by helping a greater proportion of patients achieve clear skin. The Illinois company expects to submit that med to regulators in the first half of the year, Marek Honczarenko, AbbVie’s VP of immunology development, said in a statement.

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Dermatology drugmakers may face similar issues in the atopic dermatitis market once it fills out, too, Meacham cautioned. Right now, Regeneron and Sanofi’s Dupixent is the only one in the game, but “we continue to see eventual competition to Regeneron's Dupixent,” he wrote. And once that arrives, “payers will likely be aggressive with access,” he warned.