The U.S. market for dry eye disease (DED) therapies witnessed notable developments in 2019, including Novartis’s acquisition of Xiidra and the launch of Sun Ophthalmics’ Cequa at a competitive price to Allergan’s Restasis—the market leader in DED. Moreover, the anticipated generic entry of Restasis and the launch of novel therapies (Kala Pharmaceuticals’ Eysuvis, Bausch Health’s NOV03, ReGenTree’s RGN-259, Oyster Point’s OC-01, and Aldeyra Therapeutics’ ADX-102) in the near future could influence payers’ access and reimbursement decisions in DED. Therefore, drug marketers and developers must understand how U.S. payers, ophthalmologists, and optometrists react to the evolving market dynamics in the treatment of DED.
- What formulary coverage do current drugs for moderate to severe DED receive on MCOs’ largest Medicare and commercial insurance plans? What approaches do payers use to manage utilization / costs of these drugs?
- How do various factors, including clinical factors and payer restrictions, influence ophthalmologists’ and optometrists’ prescribing to moderate to severe DED patients covered by Medicare and commercial insurance plans?
- What will be the anticipated impact of generic versions of Restasis, when available, on the formulary coverage and physician prescribing of drugs for moderate to severe DED?
- How do payers plan to reimburse key emerging drugs for DED? What would cause payers to consider preferred status / formulary inclusion of these drugs? How will the prescriber landscape for moderate to severe DED evolve by 2022?
Geography: United States
Primary research: Survey of 100 U.S. ophthalmologists and optometrists, survey of 32 U.S. MCO PDs / MDs
Fingertip formulary: Formulary coverage and restrictions data for DED therapies by commercial plans covering approximately 164 million lives and Medicare Part D plans covering 35 million lives nationally.
Key drugs covered: Restasis, Restasis MultiDose, Xiidra, Cequa, Klarity-C, Eysuvis, NOV03, RGN-259, OC-01, ADX-102
Reimbursement and contracting.
Access and prescribing.
Opportunities and challenges for emerging therapies.
Disease-specific special topic.
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.
- Detailed, Expanded Analysis (US)
- Access & Reimbursement Dry Eye Disease US April 2020
Author(s): Himanshu Jain, M.S. Pharm; Chris Lewis
Himanshu joined the CNS / ophthalmology team at Decision Resources Group in 2016. He has authored content for psychiatry and ophthalmology (retinal / nonretinal) indications, including schizophrenia, age-related macular degeneration, diabetic retinopathy / diabetic macular edema, dry eye disease, glaucoma, and uveitis. Himanshu has more than ten years of experience working in market research and consulting firms, and has managed multiple market assessment projects, including bottom-up forecasts, across multiple therapy areas. He holds a degree in Pharmacology and Toxicology from the National Institute of Pharmaceutical Education and Research in India and an Executive Post-Graduate Diploma in International Business from the Indian Institute of Foreign Trade.
Chris Lewis serves as primary research manager, Access and Reimbursement, with responsibility for coordination, content review and content generation of the market access and reimbursement insights at DRG. Content is based on online surveys of managed care organizations and physicians and expert analysis of reimbursement and prescribing patterns of key therapies treating various disease states. Lewis was an analyst/senior analyst for the group’s HealthLeaders-InterStudy subsidiary for eight years, specializing in the managed care and pharmacy benefit management industries. Throughout her tenure, she has produced the Health Plan Analysis reports for California, New York, New Jersey, Connecticut, and Pennsylvania and authored DRG’s series of pharmacy benefit manager profiles. She has also conducted numerous webinars for the group. She is a seasoned journalist with a in communications from California State University, Sacramento.