Treatment of ulcerative colitis (UC) and Crohn’s disease (CD) within Brazil and Mexico includes many of the predominant treatments in other parts of the world such as the TNF-α inhibitors. Notably, however, treatment is driven by the reimbursement status within given markets that curtail reimbursement of some therapies (with variations between public and private settings). The potential arrival of several more agents offering novel MOAs and/or formulations (e.g., Pfizer’s tofacitinib, Gilead/Galapagos’ filgotinib, Roche/Genentech’s etrolizumab), as well as increasing physician experience with prescribing biosimilars, will fuel competition and pricing pressure in these markets. Emerging therapies seeking to maximize patient shares must address the pressure points that drive reimbursement decisions within the Brazilian and Mexican markets.

Questions Answered in This Report:​​​​​​

  • What is the public and private healthcare coverage for targeted therapies in CD and UC, and how do payers’ policies and infrastructure influence access to specialized healthcare and treatments?
  • What are the current drivers and barriers for prescribing established premium-priced agents such as Humira and Remicade, or newer agents such as Entyvio?
  • What will be the impact of biosimilars on reimbursement and treatment decisions and how will this affect premium-priced agents?
  • What clinical benefits are physicians and payers looking for in emerging therapies such as etrolizumab, Xeljanz, and ozanimod? How will prescribing be impacted by expected barriers to access that result from these drugs’ prices?


Decision Resources Group’s Access and Reimbursement module for Crohn’s disease and ulcerative colitis in Brazil and Mexico explores the prescribing patterns for current targeted therapies, the potential impact of the anticipated arrival of novel therapies, and key national and regional market access factors that will shape the use of targeted therapies over the next two to three years. This content draws on insights from 101 surveyed physicians and from interviews with 6 payers in Brazil and Mexico, all of whom have influence at the regional, institutional, or national level.

Markets covered: Brazil and Mexico

Primary research:

  • 101 gastroenterologists
  • 6 payers:
    • Brazil:
      • Pharmacist, specializing in public health. Member of the Department of Health of the State of São Paulo. Senior member of CCTIES (Coordinator of Science, Technology and Strategic Health Supplies) of the State of São Paulo. Close collaborator to MoH and CONITEC.
      • Official in the Department of Health of the São Paulo State, coordinating scientific dissemination for the introduction of new technologies in the State.
      • Medical Coordinator of the Gastroenterology Diagnostics Center within a São Paulo hospital center. Participates in committees for the elaboration of protocols of the public and private hospitals.
    • Mexico:
      • Gastroenterologist and hepatologist, members of the Mexican Council of Gastroenterology, have participated in the clinical practice guidelines and recommendations of the Mexican Gastroenterology Council.
      • Department head within ISSSTE, which evaluates medicines and other medical supplies for purchase, programming, and distribution at the national level including immunomodulatory medicines.
      • Official involved with clinical guidelines at the National Center for Technological Excellence in Health (CENETEC), developing and updating clinical practice guidelines in conjunction with experts from all the institutions of the health sector.​​​​​​ ​​​​​

Table of contents

  • Detailed, Expanded Analysis (Brazil/Mexico)
    • Market Access Overview
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for New UC and CD Therapies in Brazil and Mexico
    • Successes and Stumbles
      • Successes Among UC and CD Therapies in Brazil and Mexico
      • Stumbles Among UC and CD Therapies in Brazil and Mexico
      • Brazil: Coverage Successes & Stumbles
    • Key Stakeholders in the Road to Market Access
      • Brazil
      • Mexico
    • Key Market Access Roadblocks
      • Key Market Access Roadblocks for UC and CD Therapies in Brazil and Mexico
      • Brazil: Key Market Access Roadblocks
      • Mexico: Key Market Access Roadblocks
    • Reimbursement Dynamics
      • Brazil: Coverage Dynamics for UC and CD
        • Brazil: HTA Details and Implications in Drug Coverage
        • Brazil: Drivers of Formulary Coverage
        • Brazil: Coverage & HTA Details
        • Brazil: Lessons Learned and Key Takeaways
        • Brazil: Reimbursement Background
      • Mexico: Coverage Dynamics for UC and CD
        • Mexico: HTA Details and Implications in Drug Coverage
        • Mexico: Drivers of Formulary Coverage
        • Mexico: Coverage & HTA Details
        • Mexico: Lessons Learned and Key Takeaways
        • Mexico: Reimbursement Background
    • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
      • Prescriber Preferences for UC
      • Prescriber Preferences for CD
      • Impact of Payer Policy on Prescribing for UC and CD
      • Top Prescribing Drivers: UC
      • Top Prescribing Drivers: CD
      • Key Levers and Constraints on Current Therapies
    • Market Access Landscape for Emerging Therapies
      • Likely Impact of Emerging Therapies on UC and CD
      • Market Access Challenges for Emerging Therapies for UC and CD
      • Payer Opinion on Emerging Therapies for UC and CD
    • Methodology
      • Primary Research Design
      • Physician Demographics and Practice Setting
      • Pricing
    • Appendix
      • Commercial Context
        • Epidemiology: Total Prevalence of UC and CD in Brazil and Mexico
        • Treatment guidelines for UC and CD in Brazil and Mexico
        • Key Therapies for Ulcerative Colitis and Crohn's Disease
        • Price per Year of Treatment of Select Biologics for UC and CD
        • Timeline of Launch of Key Drugs for UC and CD
        • Emerging Therapies Profiles
      • Physician Survey Data
      • About Decision Resources Group
        • Author(s) Biography

Author(s): Susana Ribeiro da Silva

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