The prevalence of rheumatoid arthritis (RA) is higher in Argentina and Mexico than in most Latin American countries and comparable to rates found in mature pharmaceutical markets. Biologics from several drug classes are available in these markets to treat RA, and most of them are covered/reimbursed by healthcare providers in each country. The high-cost of RA treatment with biologics imposes a financial burden on the public healthcare systems in this region.
- Biologic agents are usually recommended after the failure of conventional disease-modifying antirheumatic drugs (synthetic) and in cases of active and structurally progressive disease; both are prescribed to halt the destructive course of RA and prevent debilitating joint damage.
- Anti-tumor necrosis factor-alpha (Anti-TNF-α) agents are usually recommended as the initial biologic (Amgen/Pfizer’s Enbrel [etanercept], AbbVie’s Humira [adalimumab], Janssen/Merck’s Remicade [infliximab] and Simponi [golimumab], and UCB/Astellas’s Cimzia [certolizumab pegol]), but biologics with different mechanisms of action are also available for use in first-line biologic treatment (Bristol-Myers Squibb’s Orencia/Ohrencia [abatacept]) and/or in second or later lines of biologic treatment (Bristol-Myers Squibb’s Orencia/Ohrencia [abatacept], Roche’s MabThera [rituximab] and Actemra/RoActemra [tocilizumab]).
- In Mexico, there are three copies of RA biologics approved by COFEPRIS (two of etanercept and one of rituximab) that are already being prescribed by our surveyed physicians. There are no non-innovator copies of biologics for RA currently available in Argentina.
- Pfizer’s Xeljanz (tofacitinib) and Eli Lilly/Incyte’s baricitinib, both oral janus-activated kinase inhibitors, are in development in Latin America. Studies seem to show that Xeljanz and baricitinib offer strong efficacy against the signs and symptoms of RA, with a convenient oral formulation.
Our report covers the prescribing and coverage/reimbursement environment for these therapies in Argentina and Mexico, and compares attitudes of physicians and payers, to assess how the RA market access landscape will evolve in the next two to three years as the treatment armamentarium for RA expands and biosimilars increase their penetration.
This Emerging Markets Physician & Payer Forum explores the dynamics that affect sales of high-cost brands and biosimilars used to treat RA in Argentina and Mexico. The report is based on a survey of 104 prescribers (rheumatologists) and interviews with 7 payers. Interviewed payers have influence in patient access to drugs at a national or regional level and include the following:
- Argentina: Pharmacoeconomist analyst at IECS (Instituto de Efectividad Clínica y Sanitaria); Purchase director for Chronic Diseases Department at OSPRERA (Obra Social del Personal Rural y Estibadores de la República Argentina ); Purchase manager for the High Cost Program at PAMI (Programa de Atención Médica Integral); Government advisor, Division of Scientific and Technological Activities, Department of Economic Development (Ministry of Health).
- Mexico: Purchase director at a major private HMO; Director and coordinator of the IMSS’s Compulsory Program; Director at Seguro Popular, Health Services Management.