Dyslipidemia is an important modifiable risk factor for cardiovascular disease, which is one of the leading causes of death globally. Statins continue to dominate treatment of dyslipidemia, driven largely by strong physician familiarity and low cost owing to their widespread generic availability. With the positive outcomes data for certain nonstatin therapies, including Vascepa, PCSK9 inhibitors, and emerging therapies like bempedoic acid, the treatment paradigm is expected to evolve. However, the high prices of PCSK9 inhibitors and the resulting negotiations to reduce the prices of these novel agents highlight both physicians’ and payers’ preference for low-priced therapies.
- How do payers reimburse current dyslipidemia brands, such as Amgen’s Repatha and Sanofi / Regeneron’s Praluent, in 2019? What restrictions do they impose?
- What factors most heavily influence payers’ reimbursement decisions for dyslipidemia drugs?
- What role do reimbursement, restriction, and patient cost play in physicians’ decisions to prescribe therapies for dyslipidemia?
- How do payers anticipate reimbursing emerging therapies, such as the Medicines Company’s inclisiran, Esperion’s bempedoic acid, Resverlogix’s apabetalone, AstraZeneca’s Epanova, and Acasti Pharma’s CaPre post approval? What restrictions will they impose?
Geography: United States
Primary research: Survey of 50 U.S. cardiologists and 50 U.S. endocrinologists and survey of 30 U.S. managed care organizations (MCO) pharmacy and medical directors (PDs / MDs)
Key drugs covered: Livalo, Vascepa, Repatha, and Praluent
Content highlights: Reimbursement and contracting; access and prescribing; special topics; opportunities and challenges for emerging therapies
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.
- Detailed, Expanded Analysis (US)
- Access & Reimbursement Dyslipidemia US May 2019
Author(s): Pallavi Malik, M.Sc
Pallavi Malik is a business insights analyst in the Cardiovascular, Metabolic and Renal disorders team at Decision Resources Group. She obtained an degree with specializations in Biotechnology, and a Bachelor's degree in Science from the Panjab University, Chandigarh, India. Prior to joining DRG, she has worked as a Senior Business Analyst at the research firm Evalueserve. Her role involved in-depth scientific secondary research, and competitive intelligence across multiple domains (such as oncology, ophthalmology and CVD) including pipeline analysis, clinical trials assessment, disease landscaping, product and company profiling, competitor benchmarking, and opportunity assessment.