Seventy-Eight Percent of National Health Plans Will Reimburse for Emerging Oral Therapies for Multiple Sclerosis

However, the Projected High Cost of These Agents Will Drive Plans to Place Them on Higher Tiers, According to a New Report from HealthLeaders-InterStudy and Fingertip Formulary

NASHVILLE, Tenn. & GLEN ROCK, N.J.--(BUSINESS WIRE)-- HealthLeaders-InterStudy and Fingertip Formulary find that a large percentage of U.S. health plans (78 percent) will reimburse for emerging oral disease-modifying therapies for multiple sclerosis, despite the projected high cost associated with these agents. However, according to the recent Formulary Forum report entitled Formulary Advantages in Multiple Sclerosis: Health Plans Await the Arrival of Orally Administered Therapies to Compete With Existing Brands, this high annual cost of treatment will drive plans to reimburse for emerging oral therapies on less favorable tiers.

The report also finds that Novartis/Mitsubishi Tanabe Pharma’s Gilenya (fingolimod) – which launched in October 2010 – had only 47 percent of commercial plans including the first oral therapy on their formularies by January 2011. Although large plans are reimbursing for the therapy, many are covering it on a higher tier and with restrictions due to its high cost and insufficient rebates or discounts. Moreover, surveyed health plans do not see much clinical differentiation among the emerging therapies for multiple sclerosis that would lead to differential formulary advantages; instead, their concerns about the high cost will drive plans to reward only a few drugs with better tier placement than rival therapies in exchange for better discounts and rebates.

“Health plans report being interested in and likely to cover emerging oral therapies for multiple sclerosis, especially if they are cheaper than the high cost of Gilenya and the continued need for treatment alternatives,” said senior analyst Roy Moore, an author of the report. “However, due to the failure of Merck Serono/EMD Serono’s oral cladribine to gain FDA approval this past March, Gilenya will remain the market’s only oral disease-modifying treatment for multiple sclerosis for longer than anticipated.”

The new Formulary Forum report is based on a survey of 50 U.S. pharmacy directors who control formularies at national, regional and state-level managed care organizations, as well as historical formulary data from Fingertip Formulary.

About Fingertip Formulary

Fingertip Formulary (, the leading provider of access to and insight into formulary data in the United States, offers comprehensive formulary data covering commercial, Medicaid, Medicare and PBM plans, among others. Fingertip Formulary is a Decision Resources, Inc. company.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Both HealthLeaders-InterStudy and Fingertip Formulary are Decision Resources, Inc. companies. Please visit Decision Resources, Inc. at

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Erin O’Leary, 781-993-2641
[email protected]
Decision Resources, Inc.
Elizabeth Marshall, 781-993-2563
[email protected]

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