BURLINGTON, Mass., Oct. 29, 2014 /PRNewswire/ -- Decision Resources Group finds that although 80 percent of surveyed rheumatologists currently prescribe Pfizer's Xeljanz for the treatment of rheumatoid arthritis (RA), it is usually used in later lines of therapy. Physicians most frequently cite limited formulary coverage and reimbursement restrictions as reasons for not prescribing Xeljanz in earlier lines of treatment. In addition, a notable proportion of surveyed rheumatologists consider Xeljanz's safety profile to be inferior to the tumor necrosis factor (TNF)-alpha inhibitors, or they are not convinced that Xeljanz has clinically meaningful effect on structural damage, although the majority of physicians perceive Xeljanz as being at least as efficacious as TNF-alpha inhibitors on signs and symptoms as well as on remission. Emerging oral and biological agents will likely face challenges in obtaining formulary coverage and market uptake in the face of established biologics with extensive coverage. Overall, for the successful uptake of new agents in the crowded RA market, drug marketers must focus on obtaining favorable formulary positioning and drug discount programs to ensure that their agents are not relegated to later lines of therapy.
Other key findings from the U.S Physician & Payer Forum report entitled Shifts in the U.S. Rheumatoid Arthritis Market Access Landscape Due to Oral Kinase Inhibitors, New Biologics, and Biosimilars: Insights from Payers and Physicians:
- New formulations of existing biologics: Janssen's Simponi Aria (IV) and Roche's SC Actemra, new formulations of existing biologics that were recently launched, are being prescribed by the majority of surveyed rheumatologists.
- Emerging oral agents: Eighty percent of surveyed physicians intend to prescribe Eli Lilly/Incyte's emerging Jak inhibitor baricitinib within two years of availability. However, payers indicate that the agent must be offered at a large discount to Xeljanz for placement on a preferred tier.
- Impact of biosimilars entry: About two-thirds of surveyed rheumatologists anticipate prescribing biosimilar versions of adalimumab (AbbVie's Humira) and rituximab (Biogen Idec/Roche's Rituxan) within the first year of their availability. The size of the discount (compared to the brand) will impact the reimbursement of these agents.
Comments from Decision Resources Group Analyst Ronnie Yoo, Ph.D.:
- "Cost-related issues and safety reasons are the two equally common reasons non-Medicare patients who are candidates for biologics and Xeljanz are not being treated with these agents. There is room for improvement in the formulary coverage or drug coupon programs to make the premium-priced RA agents more affordable."
- "The majority of surveyed payers currently reimbursing Xeljanz indicated that the coverage of Xeljanz will not likely change despite the label expansion including structural damage data. However, a few plans may move Xeljanz to a lower tier following the label expansion, emphasizing the importance of structural data for the favorable tier placement of RA therapies."
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