The current biologics/novel oral therapy market for rheumatoid arthritis (RA) and psoriasis—two important immune indications—is crowded, with new agents with similar or new mechanisms of action expected to enter the market starting in 2014. In the United States, biologics/novel oral agents for RA and psoriasis cost $16,500-$32,000 per patient for one year of treatment. The high cost often results in reimbursement hurdles that limit patients’ ability to access these therapies. Payers often impose cost-control measures to limit the use of biologics, including prior authorization and step-therapy requirements.
As more biologics/novel oral agents enter the market, and with the anticipated approval of biosimilar versions of several marketed biologics starting in 2015, we can expect more payer restrictions, especially on the recently launched and new agents. Drug marketers must employ different strategies and find new ways to overcome the increasing barriers.
Markets covered: United States.
- Interviewed experts: Leading U.S. rheumatologists and dermatologists.
- Surveyed experts: Medical directors, U.S. health plan, >100,000 lives; Pharmacy directors, U.S. health plan, >100,000 lives. U.S. rheumatologists (Northeast, South, Midwest, West) treating RA patients (Medicare and non-Medicare beneficiaries). U.S. dermatologists (Northeast, South, Midwest, West) treating psoriasis patients (Medicare and non-Medicare beneficiaries).