The chronic pain market is sizeable in terms of both dollars and the potential patient pool; however, the current and forthcoming availability of multiple generic versions of early-line analgesics as well as the entrenchment of available treatment options in current medical practice present notable barriers to market penetration of new drugs. Nevertheless, mainstay treatments for most chronic pains—NSAIDs and opioid analgesics—are associated with significant cardiovascular and gastrointestinal side effects and the risk of abuse, respectively; these safety/tolerability risks negatively impact patients’ quality of life, especially when prescribed over the long term. In recent years, there have been several important treatment advances and regulatory approvals to address unmet need in the chronic pain space, most notably, the launch of several long-acting opioid analgesics that feature abuse-deterrent properties that make the products more difficult to abuse via certain routes of administration. The launch of these therapies, as well as the recent and potential forthcoming entry of other analgesics—many of which are alternative formulations of already-available molecules—has created and will continue to create an increasingly complex treatment landscape.

The changing treatment environment for chronic pain will continue to present to physicians and payers the challenge of considering each new therapy’s unique balance of benefits, drawbacks, risks, and rewards when making treatment and formulary decisions. Because emerging therapies will be entering a crowded and mature analgesic market, they will need to demonstrate clear clinical advantages (, improved safety), in addition to pharmacoeconomic benefits (, cost-effectiveness), compared with current therapies, if they are to attain price premiums, secure favorable formulary coverage, and garner any material share of this pain market. Furthermore, the ever-tightening reimbursement environment in the United States, coupled with the burgeoning number of available pain therapies—many of which are generically available and well established—and the growing number of opioid analgesics that feature abuse-deterrent properties will result in increased market access challenges for novel therapies. Although physicians may acknowledge the advantages of emerging pain therapies, treatment decisions will ultimately be driven by formulary coverage and tier placement; therefore, securing favorable reimbursement will be critical to ensuring uptake in the chronic pain market.

Questions Answered in This Report:

  • Understand surveyed PCPs’ and pain specialists’ current treatment of chronic pain. What chronic pain populations are the different physician types treating? What are physicians’ first- and second-line treatment choices for these populations? How might use of key analgesic drug classes/agents vary based on the physician type and/or patient population treated? What are physicians’ general impressions, with regard to clinical factors and reimbursement restrictions, of select chronic pain therapies? What factors (clinical and/or nonclinical) are impacting their treatment decisions?

  • Explore surveyed physicians’ and MCO directors’ attitudes toward select recently approved chronic pain therapies. How have/will surveyed physicians incorporate Pernix Therapeutics’ (formerly Zogenix’s) Zohydro ER (hydrocodone extended-release), Iroko’s Zorvolex (low-dose, submicron diclofenac), Purdue Pharma’s Targiniq ER (oxycodone/naloxone extended-release), and Purdue Pharma’s Hysingla ER (hydrocodone long-acting) into clinical practice, if at all? What factors are/will influence physicians’ decision to prescribe (or not prescribe) these agents? For which chronic pain populations are/will they prescribe these agents, and which current therapies are most at risk of losing share? How has/will MCO coverage, including formulary inclusion, tier placement, and reimbursement restrictions, impacted the uptake of these drugs? How does/will tier placement and cost controls for these agents compare with that of long-standing branded therapies, such as OxyContin? What lessons can drug developers learn from these agents’ uptake and formulary placement?

  • Examine surveyed physicians’ and payers’ receptivity to and expectations for emerging pain therapies. How familiar are surveyed physicians with select emerging chronic pain therapies (i.e., Pfizer/Eli Lilly’s tanezumab, Pfizer’s ALO-02, Teva’s CEP-33237, BioDelivery Science/Endo’s BEMA Buprenorphine, and GW Pharmaceuticals/Otsuka Pharmaceutical’s Sativex)? How do surveyed physicians expect to incorporate these therapies into clinical practice, if at all? What attributes of emerging analgesics will be most convincing in the decision making of MCO directors and prescribing physicians? How important are cost-effectiveness and pharmacoeconomic data in payers’ decision making, and what types of data are most influential? What cost-control measures do payers expect to place on these emerging drugs? At what price points are novel therapies most likely to gain favorable formulary status? What impact do surveyed physicians expect formulary placement and access controls to have on their prescribing of these emerging therapies?

Scope:

This U.S. Physician & Payer Forum contains insights from a survey of 141 physicians—70 primary care physicians (PCPs) and 71 pain specialists—as well as 22 medical directors and 8 pharmacy directors at MCOs. We reveal physician and payer dynamics that affect prescribing practices for the treatment of chronic pain in the United States. In this report, we explore the use, reception, and formulary status of select current and recently approved chronic pain therapies by physicians and payers across multiple chronic pain populations (e.g., cancer pain, chronic back pain). We also gauge payer and physician outlook on several late-stage emerging therapies. By understanding the attitudes and expectations of prescribers and payers toward current, recently approved, and emerging chronic pain therapies, stakeholders can gain a better understanding of the complex and changing reimbursement climate for chronic pain.

Markets covered: United States.

Primary research: Online survey of 141 physicians—70 PCPs and 71 pain specialists—and 30 MCOs (22 medical directors and 8 pharmacy directors).

Epidemiology: Cancer pain, chronic low back pain, fibromyalgia, chronic daily headache, chronic migraine, osteoarthritic pain, rheumatoid arthritis pain, postherpetic neuralgia, painful diabetic neuropathy.

Population segments: Our analysis includes discussion by select chronic pain populations, where appropriate: Cancer pain, chronic back pain, fibromyalgia, chronic daily headache, migraine, arthritic pain, painful diabetic neuropathy, postherpetic neuralgia, abdominal pain.

Author(s): Andrea Buurma

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