Hemophilia treatment is gradually consuming more U.S. payer budget dollars. The increasing cost of factor concentrate and the growing preference for prophylaxis treatment are key factors driving these costs upward. Despite hemophilia patient advocacy groups strongly pushing for coverage of all brands, formulary exclusions are starting to appear. In some states, Medicaid is doing more to control the cost of factor concentrate use (for example, by introducing preferred/nonpreferred formulary tiers). Additionally, hemophilia payers tend to focus on direct cost. Given that replacement of a joint as a result of hemophilic arthropathy will not become a reality for another 20 years, payers remain focused on what will happen over the next 18-24 months.
- How do payers reimburse hemophilia drugs in 2019, and what restrictions do they impose? Which factors most greatly influence payers’ reimbursement decisions for Genentech’s Hemlibra?
- How do payers expect access to Genentech’s Hemlibra to evolve, and for which emerging therapies do payers expect to receive coverage?
- What clinical benefits are physicians and payers looking for in emerging therapies such as Novo Nordisk’s concizumab and BioMarin’s BMN 270, and what kind of savings are payers seeking?
- What role does reimbursement, restriction, and patient cost play in physicians’ decisions to prescribe therapies for hemophilia? What patient shares can emerging therapies garner under various reimbursement scenarios?
Geography: United States
Primary Research: Survey of 100 U.S. hematologists Survey of 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs)
Key Drugs Covered: Hemlibra, Advate, Adynovate, Afstyla, Alprolix, BeneFIX, Eloctate, FEIBA, Hemlibra, Idelvion, Jivi, Kogenate, Kovaltry, Novoeight, NovoSeven, Nuwiq, Xyntha
- 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 Hemophilia US June 2019
Author(s): Kerri Brown, M Pharm
Kerri Brown, is an analyst with Decision Resources Group, focused on finding stories in data and developing products to inform strategic decisions in the hemophilia and diabetes spaces. Kerri holds a master of pharmacy degree from King’s College London with 1 st class honors. Prior to joining DRG, she was a national clinical educator at a UK diabetes start-up, and has extensive experience of diabetes medical devices. Kerri has worked at AstraZeneca, and as a pharmacist in a national psychiatric clinical trial center. In addition to her work at DRG, Kerri is a practicing pharmacist with extensive clinical experience of UK physician prescribing in diabetes.