Key finding: There is a lack of consensus among payers regarding which select factors most drive their reimbursement decisions for emerging bipolar disorder (BPD) therapies.
However, nearly one-quarter of surveyed payers considered lowest drug list price to be the most influential factors on their reimbursement decision of an emerging therapy.
Additionally, a total of 34% of surveyed payers cited a BPD therapy’s lowest drug list price and lowest net drug cost to the plan as the second most influential factor on their formulary placement of an emerging therapy.
These findings highlight the importance drug cost plays in payers’ reimbursement decisions of BPD therapies.
The “so what” for decision makers: The BPD market is highly genericized and replete with relatively effective agents that treat mania symptoms.
Drug companies with emerging therapies that do not substantially differentiate themselves from currently available therapies will need to consider offering a competitively low drug list price or substantial rebates to receive more favorable formulary placement than other therapies.
What else matters for payer decisions around bipolar disorder treatments?
The full Bipolar Disorder | Access & Reimbursement | United States report answers:
- How do payer policies affect the prescribing of branded oral atypical antipsychotics (e.g., Sunovion’s Latuda, Lundbeck/Otsuka Pharmaceutical’s Rexulti, Allergan’s Vraylar) and antidepressants (e.g., Lundbeck/Takeda Pharmaceutical’s Trintellix, Allergan’s Viibryd) in this genericized market?
- In this mature and highly generic treatment landscape, what actions can marketers of therapies used to treat BPD employ to attain successful market access and thus overall sales?
- What are the preferred pharmacoeconomic models for payers when evaluating new BPD therapies and what type of pharmacoeconomic data do they find most compelling?
- To which of their BPD patients do psychiatrists anticipate prescribing the emerging therapies ALKS-3831 (Alkermes), NRX-101 (NeuroRX), and rapastinel (Allergan)? How do payers expect to reimburse these therapies?
Markets covered: United States
Methodology: Surveyed 101 psychiatrists in the United States and 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).
Key drugs covered: ALKS-3831, aripiprazole (Abilify, generics), Latuda, lamotrigine (Lamictal, generics), lithium, NRX-101, quetiapine IR/XR (Seroquel IR/XR, generics), rapastinel, Rexulti, Trintellix, Viibryd, and Vraylar.
Key companies mentioned: Alkermes, Allergan, AstraZeneca, Lundbeck, NeuroRX, Otsuka Pharmaceutical, Sumitomo Dainippon Pharma, Sunovion, Takeda Pharmaceutical, and Valeant Pharmaceuticals.
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