The entrenched positioning of biologics (in particular, tumor necrosis factor-alpha [TNF-alpha] inhibitors) to treat moderate-to-severe rheumatoid arthritis (RA) has generated a multi-billion-dollar market. The non-TNF-alpha inhibitor agents Orencia (Bristol-Myers Squibb’s abatacept), Rituxan (Roche/Biogen Idec/Chugai/Zenyaku Kogyo’s rituximab), Actemra (Roche/Chugai’s tocilizumab), and Xeljanz (Pfizer’s tofacitinib) largely compete for TNF-alpha inhibitor-refractory patients. Additional Jak inhibitors (Eli Lilly/Incyte’s baricitinib and Galapagos’s filgotinib) and IL-6 inhibitors (Sanofi/Regeneron’s IL-6 inhibitor sarilumab and Janssen/GlaxoSmithKline’s IL-6 inhibitor sirukumab) are anticipated to launch over the next few years and to further intensify competition in the crowded RA market. In addition, biosimilar versions of Janssen’s Remicade (infliximab), AbbVie/Eisai’s Humira (adalimumab), and Rituxan are expected to launch in the United States starting in 2016, providing cost-effective alternatives to the high-cost biologics.


The Physician & Payer Forum report entitled Evolution of the Rheumatoid Arthritis Treatment Paradigm: Physician and Payer Perceptions as More Convenient Options Emerge examines the prescribing and reimbursement environment for current and emerging RA agents according to surveyed rheumatologists and managed care organization (MCO) pharmacy directors and medical directors. This report explores stakeholder perspectives that affect prescribing and reimbursement of key RA agents and dynamics that will promote or restrict market access and uptake of emerging RA therapies.

Questions Answered in This Report:

  • Prescribing and market uptake of RA biologics/Xeljanz: What are the most commonly prescribed agents for the treatment of RA? How will the availability of novel agents and biosimilars affect prescribing patterns by year-end 2018? What are the key drivers and obstacles for prescribers in the RA market? Which therapies do physicians and payers believe have an advantage in terms of various clinical and cost-related attributes?

  • Reimbursement status of RA biologics/Xeljanz: Which marketed RA biologics/Xeljanz have the most favorable coverage and tier placement on commercial and Medicare Advantage formularies? What drivers are important to MCO PD/MDs when making formulary and reimbursement decisions for RA drugs?

  • Cost-control measures and prescribing restrictions on RA biologics/Xeljanz: What types of utilization management controls are commercial and Medicare Advantage plans placing on RA biologics and Xeljanz? How frequently do prescribers encounter payer restrictions when prescribing RA biologics and Xeljanz? How do those restrictions affect their prescribing of these agents? What would physicians’ preferred RA agents be if out-of-pocket costs and reimbursement issues were not a factor?

  • Outlook for emerging RA agents: How will the novel Jak inhibitor, baricitinib, fit into physicians’ treatment algorithms for RA—will it be used in DMARD-naive patients or be reserved for TNF-refractory RA patients? How will the formulary positioning of this agent influence physician prescribing decisions? How will price factor into baricitinib’s tier placement on commercial and Medicare Advantage plans? What are prescriber and payer perceptions of remaining unmet needs in RA?

Scope:

Markets covered: United States.

Primary research: Online survey of 102 rheumatologists and 30 MCOs (10 medical directors and 20 pharmacy directors).

Population segments: Our analysis involves patients covered under commercial and Medicare Advantage health plans.

Author(s): Ronnie Yoo, Ph.D.

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