ICER’s review of RA therapies cited several actions payers may want to take to address the cost trends and access issues surrounding these agents.

Key finding: In April 2017, the Institute for Clinical and Economic Review (ICER) published a report on targeted RA therapies. The ICER report found that none of these therapies were cost effective, based on a maximum of $150,000 per quality adjusted life year (QALY) gained, and that discounts of as much as 29-69% would be required to reach this QALY threshold.

What do managed care organization (MCO) medical and pharmacy directors (MD/PDs) say? In research conducted by DRG, over half (53%) of surveyed MCO MD/PDs reported that they expect to set reimbursement criteria for emerging therapies based on the ICER analysis. Among six selected ICER-recommended strategies, most PDs/MDs report that their MCOs are somewhat or very likely adopt all of them.

The “so what” for strategists: Manufacturers should expect that health economic and outcomes research/pharmacoeconomic (HEOR/PE) data will be important for making their case for formulary inclusion and should carefully consider how the quality and amount of data will impact their agent’s profile.


What else matters for payer decisions around emerging Rheumatoid Arthritis treatments?

See what’s covered in the full report: Rheumatoid Arthritis | Access & Reimbursement | US

Key questions answered in the analysis:

  • What are physicians’ and payers’ initial reactions to Inflectra and Renflexis, and how will their market entry impact physician prescribing and reimbursement of Remicade?
  • What types of pharmacoeconomic outcomes data do payers find most compelling for a novel RA therapy?
  • What are current physician perceptions of emerging Jak inhibitors Olumiant (Eli Lily/Incyte), upadacitinib (AbbVie), and filgotinib (Galapagos/Gilead), compared with Xeljanz?
  • How will rheumatologists’ prescribing of established biologics by line of therapy shift with the entry of multiple novel or less costly agents, including additional Jak inhibitors, and biosimilar versions of Remicade, Rituxan, and Orencia?
Markets covered: United States.
Methodology: Survey of 100 rheumatologists in the United States in addition to 30 managed care organization (MCO) pharmacy and medical directors (PDs/MDs).
Indication coverage: Rheumatoid arthritis
Key drugs covered: Current therapies: Humira, Enbrel, Remicade, Simponi, Simponi Aria, Cimzia, Inflectra, Renflexis, Orencia, Rituxan, Actemra, Kevzara, Xeljanz. Emerging therapies: Olumiant, upadacitinib, filgotinib, piclidenoson.
Key companies mentioned: AbbVie, Amgen, Bristol-Myers Squibb, Can-Fite BioPharma, Eli Lilly, Galapagos, Gilead, Incyte, Janssen, Pfizer, Roche, Regeneron, Sanofi, and UCB


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