Introduction: This research explores the reimbursement and utilization landscape for anti-osteoporotic drugs. The osteoporosis market is characterized by the availability of low-cost generic oral bisphosphonates that are effective and dominate the earlier lines of osteoporosis treatment. More costly branded drugs, including Prolia (Amgen’s denosumab), Forteo (Eli Lilly’s teriparatide), and Tymlos (Radius Health’s abaloparatide SC), are injectable and have been shown to have efficacy superior to the bisphosphonates. Branded injectable therapies typically feature in second or later lines of therapy, reserved for the most severe cases of osteoporosis. With generics giving payers leverage to control drug prices in osteoporosis, this report’s data-driven analysis helps developers of novel anti-osteoporotic drugs understand the influence of clinical and economical factors affecting market access and medical practice in the United States.

Questions Answered in This Report:

  • Which anti-osteoporotic drugs commonly receive favorable formulary placement, and what approaches do payers employ to manage utilization and costs?
  • How are MCOs performing value assessments for anti-osteoporotic drugs, and what are the preferred pharmacoeconomic models?
  • How successful is Radius Health in gaining market access for its recently launched parathyroid hormone analogue Tymlos?
  • How will emerging anti-osteoporotic drugs be reimbursed and prescribed in a market dominated by generic oral bisphosphonates?

Scope:

  • Markets covered: United States.
  • Methodology: Surveys of 50 PCPs, 32 endocrinologists, and 22 rheumatolgists as well as 30 managed care organization (MCO) officials in September 2017.
  • Indication coverage: Osteoporosis.
  • Key Drugs covered: Prolia, Forteo, Tymlos, alendronate (Fosamax), risedronate (Actonel), zoledronate (Reclast), ibandronate (Boniva).
  • Key companies mentioned: Amgen, Eli Lilly, Radius Health, Merck, Novartis, Roche/GlaxoSmithKline.

Table of contents

  • Detailed, Expanded Analysis (US)
    • Market Access Overview
      • Overview of Market Access in Osteoporosis
    • Actionable Recommendations to Optimize Market Access
      • Actionable Recommendations to Optimize Market Access
    • Successes and Stumbles
      • Overview of Successes and Stumbles for Osteoporosis
      • Successes Among Osteoporosis Therapies in the United States: Physicians
      • Stumbles Among Osteoporosis Therapies in the United States: Physicians
      • Successes Among Osteoporosis Therapies in the United States: MCOs
      • Stumbles Among Osteoporosis Therapies in the United States: MCOs
    • 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: Commercial Managed Care Organizations
        • Reimbursement Summary
        • Pricing, Reimbursement, and Value Drivers for Osteoporosis
        • Cost-Sharing and 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 Osteoporosis
      • 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 for Osteoporosis
      • Potential Placement of Emerging Therapy at Various Prices
        • Potential Reimbursement of Emerging Therapies for Osteoporosis
      • Prescriber and MCO Priorities for Emerging Therapy Evaluation
        • Key Findings
    • Methodology
      • Primary Market Research Methodology: Physicians
        • Physician Demographics
      • Primary Market Research Methodology - MCOs
        • MCO Demographics
    • Appendix
      • Physician Survey
      • MCO Survey

Author(s): Surbhi Gupta, Masters in Pharmacy

Surbhi Gupta is an Insights analyst in the Cardiovascular, Metabolic and Renal disorders team at Decision Resources Group and has worked on contents on pulmonary hypertension and obesity. She completed her Masters with specialization in Pharmacology, and a Bachelor's degree in Pharmacy from the University Of Delhi. Before joining DRG, she has worked as a Senior Business Analyst at the research firm Evalueserve, where she was involved in competitive intelligence projects across multiple indications (such as atrial fibrillation, ACS, VTE, renal anemia, and several oncology indications). She also worked as a Medical writer at the clinical research organization, Apcer Pharma.


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