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Unipolar Depression | Access & Reimbursement | Detailed, Expanded Analysis Schizophrenia and Major Depressive Disorder (Brazil and Mexico)

Unipolar Depression | Access & Reimbursement | Detailed, Expanded Analysis Schizophrenia and Major Depressive Disorder (Brazil and Mexico)

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Introduction

The prevalence of the often disabling psychiatric diseases schizophrenia and major depressive disorder (MDD) is growing in Brazil and Mexico. Antipsychotics (older typical or newer atypical antipsychotics) are the standard of care for schizophrenia and an increasingly popular option for  patients with treatment-resistant depression (TRD). In an over-genericized market of well-established key agents, the uptake of new antipsychotics is hampered by stringent budgets and market access obstacles. However, high unmet need remains for therapies with demonstrated efficacy for both conditions. In this Access & Reimbursement analysis, we discuss the current access landscape for antipsychotics in Brazil and Mexico, with a focus on atypical antipsychotics’ use in schizophrenia and TRD. Based on primary research with psychiatrists and payers in these two countries, we also analyze the future uptake of emerging therapies (e.g., Lundbeck/Otsuka’s brexpiprazole) and pinpoint the levers of and roadblocks to their success.

Scope:

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

Markets covered: Brazil and Mexico.

Primary research:

  • 101 psychiatrists
  • 6 payers:
    • Brazil:
      • Member of the Pharmacology Commission in São Paulo’s State Health Department.
      • Medical audit department manager at national HMO.
      • Psychiatrist KOL.
    • Mexico:
      • Head of acquisition and distribution of medicines at ISSSTE.
      • Psychiatrist KOL.
      • Chief of the psychiatry department at an IMSS’s hospital; P&T committee member.

Questions Answered in This Report:

  • How do coverage of antipsychotics for schizophrenia and MDD vary between the profiled countries and public/private settings?
  • How cost- and coverage-related constraints drive psychiatrists’ prescribing patterns for schizophrenia and MDD?
  • Which are the most prescribed and most preferred antipsychotics for the treatment of schizophrenia and MDD? What are the key drivers for the prescribing of one antipsychotic over others? 
  • To which extent generic availability impacts P&R of branded antipsychotics?
  • How are payers’ expectations for emerging therapies? How will market access barriers evolve, and what challenges will emerging therapies for schizophrenia and MDD be most likely to face in the future?
  • What role will head-to-head trials and pharmacoeconomic outcomes play in the coverage of novel agents versus current standards of care?
  • How do psychiatrists expect to prescribe emerging antipsychotics, and what is their likely impact on current brands in the next three years?

Table of contents

  • Detailed, Expanded Analysis Schizophrenia and Major Depressive Disorder (Brazil and Mexico)
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for New Antipsychotics in Brazil and Mexico
    • Successes and Stumbles
      • Successes Among Atypical Antipsychotics for Schizophrenia and Major Depressive Disorder in Brazil and Mexico
      • Stumbles Among Atypical Antipsychotics for Schizophrenia and Major Depressive Disorder in Brazil and Mexico
      • Brazil: Coverage Successes and Stumbles
      • Mexico: Coverage Successes and Stumbles
    • Key Stakeholders in the Road to Market Access
      • Brazil
      • Mexico
    • Key Market Access Roadblocks
      • Key Market Access Roadblocks for Antipsychotics in Brazil and Mexico
      • Brazil: Key Market Access Roadblocks
      • Mexico: Key Market Access Roadblocks
    • Reimbursement Dynamics
      • Brazil: Reimbursement Dynamics for Antipsychotics
        • Brazil: HTA Details and Implications for Drug Coverage
        • Brazil: Drivers of Formulary Coverage for Schizophrenia and Major Depressive Disorder
        • Brazil: Coverage and HTA Details for Antipsychotics
        • Brazil: Lessons Learned and Key Takeaways
        • Brazil: Reimbursement Background
      • Mexico: Reimbursement Dynamics for Antipsychotics
        • Mexico: HTA Details and Implications for Drug Coverage
        • Mexico: Drivers of Formulary Coverage for Antipsychotics for Schizophrenia and Major Depressive Disorder
        • Mexico: Coverage Details for Antipsychotics
        • Mexico: Lessons Learned and Key Takeaways
        • Mexico: Reimbursement Background
    • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
      • Prescriber Preferences for Schizophrenia
      • Prescriber Preferences for Major Depressive Disorder
      • Impact of Payer Policy on Prescribing for Schizophenia and Major Depressive Disorder
      • Top Prescribing Drivers: Schizophrenia
      • Top Prescribing Drivers: Major Depressive Disorder
      • Payer Policy Uptake Constraints
      • Key Levers for and Constraints on Current Therapies
    • Market Access Landscape for Emerging Therapies
      • Likely Impact of Emerging Antipsychotics
      • Market Access Challenges for Emerging Antipsychotics for Schizophrenia and Major Depressive Disorder
      • Payer Opinion on Emerging Antipsychotics for Schizophrenia and Major Depressive Disorder
    • Methodology
      • Primary Research Design
      • Physician Demographics and Practice Setting
        • How would you best describe the setting(s) in which you practice?
        • Mexico: What is your public hospital affiliation?
    • Appendix
      • Commercial Context
        • Epidemiology: Prevalence of Schizophrenia and Major Depressive Disorder in Brazil and Mexico
        • Treatment Guidelines for Schizophrenia and Major Depressive Disorder in Brazil
        • Treatment Guidelines for Schizophrenia and Depressive Disorder in Mexico
        • Key Atypical Antipsychotics for Schizophenia and Major Depressive Disorder
        • Price per Day of Treatment for Atypical Antipsychotics for Schizophrenia
        • Timeline of Launch/Approvals of Key Atypical Antipsychotics for Schizophrenia and Major Depressive Disorder
        • Emerging Therapies Profiles
      • Physician Survey Data
        • Open End Responses: Formulary Inclusion of Atypical Antipsychotics for Schizophrenia
        • Open End Responses: Formulary Inclusion of Atypical Antipsychotics for Major Depressive Disorder
        • Open End Responses: Formulary Inclusion of Atypical Antipsychotics for Schizophrenia
        • Open End Responses: Formulary Inclusion of Atypical Antipsychotics for Major Depressive Disorder
        • Open End Responses: Common Access Routes to Antipsychotics When Available or Uncovered
        • Open End Responses: Percentages of Patients With Schizophrenia Receiving Haloperidol Versus Other Typical Antipsychotics
        • Open End Responses: Patient Shares for Atypical Antipsychoitcs: Schizophrenia
        • Open End Responses: Reasons for Delaying or Foregoing Treatment With Antipsychotics
        • Open End Responses: Most Used Antipsychotics for the Negative Symptoms of Schizophrenia
        • Open End Responses: Physicians' Choice of Treatment for Schizophrenia Without Access Barriers
        • Open End Responses: Patient Shares for Atypical Antipsychoitcs for Treatment-Resistant Depression

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  • Pub Date: August 2016
  • Author(s): Andreia Ribeiro, PhD; Susana Ribeiro da Silva
  • Andreia Ribeiro, is a Director in DRG’s Market Access Insights team. In this role, she manages the Emerging and European Markets Access & Reimbursement portfolios, the industry’s only primary market research solution that includes insights from both physicians and payers to get a true sense of how both parties determine access to key pharmaceutical markets. She joined DRG over 4 years ago as a Latin American analyst where she has pioneered extensive primary and secondary research in the Brazil, Mexico, and Argentina payer systems exploring how the different reimbursement contexts impact prescribing. Dr. Ribeiro has a in chemical and biochemical engineering from the University of Maryland Baltimore County focused on translational biomaterials research. She holds a degree from the University of Porto and two professional certifications in biochemical regulatory engineering and biotechnology management. A native of Portugal, Dr. Ribeiro is fluent in Portuguese and Spanish.

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