Research and Markets: Formulary Advantages in Chronic Pain Therapies: How Will Price Impact the Coverage of Expensive Abus

DUBLIN--(BUSINESS WIRE)-- Research and Markets ( has announced the addition of Decision Resources, Inc.'s new report "Formulary Advantages in Chronic Pain Therapies: How Will Price Impact the Coverage of Expensive Abuse-Deterrent Opioids and Biologics?" to their offering.

Chronic pain is a multi-billion dollar market saturated with well-established branded and generic analgesics that are only partially effective. While drugs with novel mechanisms of action that offer greater efficacy will contribute to market growth, reformulations of current therapies that offer improved convenience, tolerability, or abuse-deterrence will inevitably be more expensive than current generics and will likely replace low-cost generics only in specific niche populations.

New agents such as Pfizers tanezumab, the first biologic to treat chronic pain, and Kings Embeda (morphine SR and naltrexone), the first abuse-deterrent opioid analgesic on the U.S. market, address unmet needs in the chronic pain market. However, managed care organizations (MCOs) will seek to limit these agents use to specific patient populations to control the cost of these expensive therapies.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of chronic pain treatments, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.

Questions answered in this report:

  • The large number of generic drugs already available and the impending generic entry of several key therapies are drivers for the increasingly difficult reimbursement environment in the chronic pain market. How are chronic pain drugs currently reimbursed on commercial and Medicare formularies? What formulary restrictions are placed on the drugs for reimbursement? Are the rebates of currently-marketed branded therapies more or less generous than those of other key brands? How did the launch of generics and new agents affect the reimbursement of key brands, such as Johnsons Topamax (topiramate), Pfizers (formerly Wyeths) Effexor ER (venlafaxine) and Eli Lillys Cymbalta (duloxetine)?
  • As a biologic, tanezumab will cost much more than currently-marketed therapies for chronic pain. For what osteoarthritis and back pain populations will MCOs reimburse therapy with tanezumab? How is reimbursement of tanezumab affected by the list price of the drug? As an IV-infused drug, tanezumab will require administration by healthcare professionals; will MCOs cover the drug as a pharmacy or medical benefit?
  • Eleven new chronic pain therapies are expected to launch in the next three years. If approved by the FDA, which of these emerging agents do surveyed pharmacy directors expect their MCOs will cover on their private and Medicare formularies? Which emerging agents do surveyed pharmacy directors expect to require step therapy before reimbursement? What specific product attributes will new treatments require in order to achieve equal reimbursement to current brands?

Key Topics Covered:

1. Key Findings

2. Introduction, Data Sources, and Methodology

3. Market Overview

4. Current Rebates

5. Current Tier Placement and Restrictions

a) Tier Placement

b) Formulary Restrictions

c) Off-Label Restrictions

6. Quarterly Shifts in Tier Placement

a) Commercial

b) Medicare

7. Quarterly Shifts in Prior Authorization and Step Therapy Restrictions

a) Commercial

b) Medicare

8. Expected Coverage for Emerging Agents

9. Expected Restrictions for Emerging Agents

10. Impact of Price on Expected Tier Status of Emerging Agents

a) Remoxy

b) Naproxcinod

c) Vimovo and HZT-501

11. Impact of Price on Expected Coverage of Tanezumab

a) For Osteoarthritis

b) For Back Pain

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Research and Markets
Laura Wood, Senior Manager,
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INDUSTRY KEYWORDS:   Health  Pharmaceutical