Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that Johnson & Johnson's Prezista and Wyeth's Pristiq will fall short of blockbuster status owing to payer restrictions. Although Prezista has received favorable tier placement and patient advocacy and is recognized as providing a significant therapeutic advance, the current target population for the drug is very small. Prezista is currently approved, in combination with Abbott's Norvir, for treatment-experienced HIV patients that have failed more than one protease inhibitor. However, payers in the United States and Europe are likely to restrict reimbursement to treatment- experienced HIV patients, limiting the potential for the drug. Unlike Prezista, Pristiq is perceived by U.S. and European payers to have little or no value over its predecessor drug. Therefore, unfavorable reimbursement in Europe and payer controls such as third tier status with restrictions in the U.S. will limit the use of the product.
The new special report entitled Potential Blockbusters: U.S. and European Payers Share Insight on Which Brands Will Succeed and Which Will Fall Short also finds that U.S. and European payers expect to increase restrictions on reimbursement of high-priced oncology products and will increasingly define specific patient populations eligible for reimbursement. The question of value in premium-priced oncology agents is already evident in current U.S. payer behavior. This report indicates that up to 25% of managed care organizations do not cover both agents when two similar targeted agents are available. Marketers of Tykerb, Nexavar, Sutent, and Bristol-Myers Squibb's Sprycel need to address the fact that some managed care organizations appear to perceive Herceptin/Tykerb, Nexavar/Sutent and Novartis's Gleevec/Sprycel as three pairs of interchangeable "me-too" agents.
"In this increasingly cost-conscious environment, the pharmaceutical industry is aware that for a drug to be successful, the company needs to understand not only how and to what extent physicians will use the agent but also how payers will frame their reimbursement decisions -- especially for drugs that could reach or exceed $1 billion in sales," said Alice von Loesecke, Ph.D., senior director at Decision Resources. "We found that payers may have very different needs when it comes to the product and disease- specific data that pharmaceutical companies should provide to maximize the value of their product in the payer's mind. In communicating product value, companies also have powerful allies -- the physicians and patients."
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