The landscape of prescription drugs to manage pain in the postoperative setting represents a sizable but fragmented and challenging environment for drug marketers given the abundance of generically available analgesics. As the treatment landscape for postoperative pain becomes increasingly complex, we explore the market access opportunities and challenges for drug marketers, particularly in an era of ever-tightening reimbursement in the United States. Research and analysis in this report will assess physician prescribing practices of current analgesics for postoperative pain treatment, including drugs delivered by patient-controlled administration (i.e., The Medicines Company’s Ionsys), the impact of hospital protocols and other restrictions on prescribing, and the expected uptake and formulary coverage of emerging pain therapies.

Questions answered:

  • With many generics available, hospital pharmacies use a variety of measures to control utilization of branded therapies. Which postoperative pain agents and classes commonly receive favorable hospital formulary placement, and what approaches are employed to manage utilization and costs? Which restrictions are most common for selected branded agents?
  • The costs of many surgical procedures and associated aftercare are often reimbursed via bundled payments from payers.  What is the impact of payment bundling for surgical procedures on prescribing and reimbursement practices related to postoperative pain management?
  • Throughout the pharmaceutical industry, pharmacoeconomic assessments are becoming more commonplace. How are hospital PDs performing value assessment for postoperative pain agents, and what are the preferred pharmacoeconomic models? Is cost-effectiveness data required for P&T committee formulary coverage reviews?
  • A number of ETs are in development for the treatment of moderate to severe postoperative pain. How do hospital PDs anticipate including emerging pain therapies on formularies at various price points, and how do physicians anticipate incorporating them in the treatment of postoperative pain?
  • Scope:
    • Markets covered: United States.
    • Methodology: Survey of 52 surgical specialists, 54 anesthesiologists, and 30 hospital PDs in the United States, completed in April 2017.
    • Indication coverage: Moderate to severe postoperative pain.
    • Key drugs covered: Caldolor, Dyloject, Exparel, Ionsys, Ofirmev, Opana (parenteral), Sprix.
    • Key companies mentioned: Cumberland Pharmaceuticals, Pfizer, Pacira Pharmaceuticals, The Medicines Company, Mallinckrodt Pharmaceuticals, Endo Pharmaceuticals, Egalet.

Table of contents

  • Detailed, Expanded Analysis (US)
    • Key Updates
      • December 2017
      • September 2017
    • Market Access Overview
    • Actionable Recommendations to Optimize Market Access
    • Successes and Stumbles
      • Overview of Successes and Stumbles for Postoperative Pain
      • Successes Among Postoperative Pain Therapies in the United States: Physicians
      • Stumbles Among Postoperative Pain Therapies in the United States: Physicians
      • Successes Among Postoperative Pain in the United States: Hospital PDs
      • Stumbles Among Postoperative Pain in the United States: Hospital PDs
    • Key Stakeholders in the Road to Market Access
      • United States: Stakeholder Dynamics in the Road to Reimbursement
      • Healthcare Coverage in the United States
    • Key Market Access Roadblocks
    • Reimbursement Dynamics
      • United States: Hospital Pharmacies
        • Reimbursement Summary
        • Pricing, Formulary Inclusion, and Value Drivers for Postoperative Pain
        • Formulary Restrictions
    • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
      • Patient Share in Key Payer Channel
        • Key Findings
        • Treatment Decision Drivers
      • Prescriber Preference
        • Prescriber Preferences for Postoperative Pain
      • Impact of Restrictions on Prescribing
        • Payer Policy Impact on Prescribing: Key Findings
    • Market Access Landscape for Emerging Therapies
      • Impact of Emerging Therapies on Prescribing
        • Likely Impact of Emerging Therapies on Postoperative Pain
      • Potential Placement of Emerging Therapies at Various Prices
        • Potential Reimbursement of Emerging Therapies for Postoperative Pain
      • Prescriber and Hospital PD Priorities for Emerging Therapy Evaluation
        • Key Findings
    • Methodology
      • Primary Market Research Methodology: Physicians
        • Physician Demographics
      • Primary Market Research Methodology: Hospital PDs
        • Hospital PD Demographics
    • Appendix
      • Physician Survey
      • Hospital PD Survey
      • Bibliography

Author(s): Margaret M. Weigel; Emma McFadden, PhD

Margaret Weigel, is a Business Insights Analyst on the CNS/Ophthalmology Disorders team at Decision Resources Group. Her specialties are diabetic retinopathy/diabetic macular edema, postoperative pain, and multiple sclerosis; she has authored numerous primary and secondary market research products on these indications. Ms. Weigel obtained her from Washington and Lee University, where she studied psychology and conducted research in the neuroscience department, and her in pharmaceutical and healthcare business from the University of the Sciences in Philadelphia.

Emma McFadden, is a  Director within the Central Nervous System/Ophthalmology disorders group. Her main focus is on ophthalmic indications, such as age-related macular degeneration, diabetic retinopathy, and diabetic macular edema, although she has authored research across a number of other indications, including multiple sclerosis and ; Prior to joining Decision Resources Group, Emma earned a in neuroscience and a in biochemistry from Trinity College Dublin.  

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