TNF-α inhibitors are well entrenched in the U.S. ulcerative colitis (UC) and Crohn’s disease (CD) markets. Newer biologics that offer alternative treatment options (i.e., Takeda’s Entyvio and Janssen’s Stelara) as well as the increasing penetration of biosimilar infliximab (e.g., Pfizer’s Inflectra) continue to expand the UC/CD treatment landscapes. The launch of Xeljanz in 2018, the first oral agent and first JAK inhibitor in UC, will further shift UC market dynamics. Additionally, the arrival of emerging agents—some with novel MOAs—including Gilead/Galapagos’s filgotinib, Celgene’s ozanimod, and Roche’s etrolizumab, and the increasing physician prescribing of biosimilars will fuel competition and add to pricing pressure. Emerging therapies seeking favorable uptake in UC and/or CD will face a growing number of market access challenges.

QUESTIONS ANSWERED

  • How do MCO restrictions impact physicians’ prescribing of biologics/oral targeted agents to their UC or CD patients?
  • What is the current and expected formulary placement of key biologics/oral targeted agents (e.g., Xeljanz), and how are utilization management strategies used by MCOsto control costs of these agents?
  • How do payers expect to cover emerging therapies on their commercial health plans at various price points, and how does this coverage align with physicians’ anticipated prescribing of these agents?

CONTENT HIGHLIGHTS 

Geography: United States.

Primary Research: Survey of ~100 U.S. gastroenterologists and ~30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).

Key Drugs Covered: Remicade, Humira, Biosimilar infliximab, Simponi, Cimzia, Entyvio, Stelara, Xeljanz.

Content highlights: Reimbursement and contracting; access and prescribing; special topics; opportunities and challenges for emerging therapies.

PRODUCT DESCRIPTION

U.S. Access & Reimbursement provides in-depth insight on the impact of payer policy on prescribing behavior so that clients can build their market access strategy and optimize their brand positioning. This analysis of primary market research with physician specialists and U.S. payers helps clients stay up-to-date on restriction policies, gauge payer and prescriber attitudes toward specific therapies, identify opportunities where brands can capture patient share through market access, and maximize opportunities for emerging therapies by learning how previous brands gained favorable reimbursement or why they stumbled.

Table of contents

  • Detailed, Expanded Analysis (US)
    • Access and Reimbursement Ulcerative Colitis Crohn's disease US August 2019

Author(s): Qinghui Yu, PhD; Chris Lewis

Qinghui Yu is a business insights analyst at Decision Resources Group. She has authored market research reports analyzing market trends in autoimmune diseases. Prior to joining Decision Resources Group, Dr. Yu worked as a senior analyst for a life science consulting firm, where she worked on a range of projects providing strategic growth advice to clients in life science ;Qinghui Yu holds a in Neuroscience from Columbia University.

Chris Lewis serves as primary research manager, Access and Reimbursement, with responsibility for coordination, content review and content generation of the market access and reimbursement insights at DRG. Content is based on online surveys of managed care organizations and physicians and expert analysis of reimbursement and prescribing patterns of key therapies treating various disease states. Lewis was an analyst/senior analyst for the group’s HealthLeaders-InterStudy subsidiary for eight years, specializing in the managed care and pharmacy benefit management industries. Throughout her tenure, she has produced the Health Plan Analysis reports for California, New York, New Jersey, Connecticut, and Pennsylvania and authored DRG’s series of pharmacy benefit manager profiles. She has also conducted numerous webinars for the group. She is a seasoned journalist with a in communications from California State University, Sacramento.


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