You know that old adage: The one with the gold makes the rules? That's increasingly true in the drug business. The FDA may be a new drug's biggest hurdle, but payers are throwing up more obstacles as high-tech treatments get pricier and healthcare costs keep rising.
For the latest exhibit, look no further than Pfizer's ($PFE) anticipated rheumatoid arthritis treatment tofacitinib. After an FDA advisory panel voted in favor of the drug last week, Reimbursement Intelligence surveyed 30 big payers, asking how they'd manage access to the new treatment if it wins final approval. More than three-fourths of payers said they'd require patients to fail on at least one TNF inhibitor, such as Abbott Laboratories' ($ABT) Humira and Johnson & Johnson's ($JNJ) Remicade, before turning to Pfizer's new med.
What's particularly striking about these survey results is that the payers' attitudes changed after the AdComm meeting. After the discussion and vote, "substantially more payers ... said they would require failure of two anti-TNFs before allowing access to tofacitinib," Reimbursement Intelligence CEO Rhonda Greenapple said in a release.
Apparently, some payers took the FDA panel's opinions to heart. For instance, the committee said that it wasn't possible to draw conclusions about tofacitinib's effects on structural damage from RA. Forty percent of payers rated their perception of tofacitinib as "unfavorable" after reviewing that assessment, Greenapple said; before the discussion, none of the payers had a unfavorable reaction.
What's most important to Pfizer, of course, is how many patients turn to the new drug. These payers weren't gung-ho about that uptake, either: Six months after launch, they expect a 6% market share for tofacitinib 6 months after launch and 13% after one year. "That's surprisingly low," Greenapple said. Pfizer will have to hope that payers' ideas shift once again after the drug hits the market.
- see the Reimbursement Intelligence release