Schizophrenia and major depressive disorder (MDD) are disabling psychiatric conditions that are linked to a heavy economic and disease burden on society and patients as well as their caregivers. Antipsychotics (older typical or newer atypical antipsychotics) are the standard of care for schizophrenia, and they are also used among treatment-resistant MDD patients. In an overgenericized market of well-established, mostly reimbursed key agents, psychiatrists may be reluctant to switch to newer and more expensive treatment options. 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 China, with a focus on atypical antipsychotics’ use in schizophrenia and MDD. In addition, we analyze the future uptake of emerging therapies (e.g., Sumitomo Dainippon’s Latuda) and pinpoint the levers and roadblocks to their success.

Table of contents

  • Schizophrenia - Access & Reimbursement - Detailed, Expanded Analysis Schizophrenia And Major Depressive Disorder (China)
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for New Antipsychotics for Schizophrenia and MDD in China
    • Successes and Stumbles
      • Successes Among Schizophrenia and MDD Therapies in China
      • Stumbles Among Schizophrenia and MDD Therapies in China
      • China: Reimbursement Successes and Stumbles
      • Key Stakeholders in the Road to Market Access
        • China
      • Key Market Access Roadblocks
        • Key Market Access Roadblocks for Antipsychotics for Schizophrenia and MDD in China
      • Reimbursement Dynamics
        • China: Reimbursement Dynamics for Antipsychotics for Schizophrenia and MDD
          • China: Drivers of Formulary Coverage for Antipsychotics
          • China: Reimbursement Details for Antipsychotics for Schizophrenia and MDD
          • China: Key Background Details of the Healthcare System
          • China: P&R Process
          • China: Treatment Guidelines and Medicine Rate
      • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
        • Prescriber Preferences for Current Antipsychotics for Schizophrenia
          • Most-Preferred Agents: Physicians' Current Choice of Atypical Antipsychotics for Schizophrenia
          • Most-Preferred Agents: Physicians' Choice of Antipsychotics for Schizophrenia in a Scenario of 100% Funding/Reimbursement
        • Prescriber Preferences for Current Antipsychotics for MDD
          • Most-Preferred Agents: Physicians' Current Choice of Atypical Antipsychotics for Treatment-Resistant MDD
          • Most-Preferred Agents: Physicians' Choice of Atypical Antipsychotics for MDD in a Scenario of 100% Funding/Reimbursement
        • Impact of Payer Policy on Prescribing for Schizophrenia and MDD
          • Patients Not Receiving Antipsychotics Due to Cost, Budgetary, and Reimbursement Reasons
          • Cost, Budgetary, and Reimbursement Reasons for Schizophrenia Patients Not Receiving Typical or Atypical Antipsychotics
          • Cost, Budgetary, and Reimbursement Reasons for MDD Patients Not Receiving Typical or Atypical Antipsychotics
        • Top Prescribing Drivers: Schizophrenia
          • Top Prescribing Drivers: MDD
            • Key Levers and Constraints on Current Therapies
            • Market Access Landscape for Emerging Therapies
              • Likely Impact of Emerging Therapies on the Treatment of Schizophrenia
                • Top Prescribing Drivers of Emerging Atypical Antipsychotics for Schizophrenia
                • Replacement of Existing Antipsychotics with Emerging Atypical Antipsychotics
              • Likely Impact of Emerging Therapies on the Treatment of MDD
                • Top Prescribing Drivers of Emerging Atypical Antipsychotics for MDD
                • Replacement of Existing Antipsychotics with Emerging Atypical Antipsychotics for the Treatment of MDD
              • Market Access Challenges for Emerging Therapies for Schizophrenia and MDD
                • China: Payer Opinion on Emerging Therapies for Schizophrenia and MDD
                  • China: Payer Opinion on Emerging Therapies for Schizophrenia
              • Methodology
                • Abbreviations
                • Primary Research Design
                • Background of Payers and Payer-Advising KOLs
                • Physician Demographics and Practice Setting
                  • What is your specialty?
                  • How many years have you practiced post-residency?
                  • How many adult patients with the following conditions do you treat per month?
                  • In what city is your practice located?
                  • In which province is your practice located?
                  • What type of hospital(s) do you practice at?
                  • What percentage of your patients with schizophrenia and MDD do you currently treat with atypical antipsychotics and with typical antipsychotics?
              • Appendix
                • Commercial Context
                  • Major Depressive Disorder 12-Month Prevalent Cases
                  • Schizophrenia Diagnosed Lifetime Prevalence
                  • Treatment Algorithm for Schizophrenia in China (positive symptoms)
                  • Treatment Algorithm for Schizophrenia in China (negative symptoms)
                  • Treatment Guideline for MDD in China
                  • Profiles of Key Atypical Antipsychotics for Schizophrenia in China
                  • Daily Price of Select Atypical Antipsychotics
                  • Pricing Methodology
                  • Timeline of Launch of Key Current and Emerging Therapies
                  • Emerging Therapy Profile: Seroquel (Quetiapine XR)
                  • AstraZeneca's Seroquel (Quetiapine XR)
                  • Emerging Therapy Profile: Latuda (Lurasidone)
                  • Sumitomo Dainippon's Latuda (Lurasidone)
                  • Emerging Therapy Profile: Lonasen (Blonanserin)
                  • Sumitomo Dainippon's Lonasen (Blonanserin)
                • Physician Survey Data
                  • Medicine Rate Target in Psychiatrists' Hospitals
                  • Effect of Medicine Rate on Antipsychotics Prescription
                  • Reasons Medicine Rate Not Affecting Psychiatrists' Prescription
                  • Reasons Medicine Rate Affecting Psychiatrists' Prescription
                  • Patients Not Receiving Antipsychotics Due to Cost, Budgetary, and Reimbursement Reasons
                  • Cost, Budgetary, and Reimbursement Reasons for Schizophrenia Patients Not Receiving Typical or Atypical Antipsychotics
                  • Cost, Budgetary, and Reimbursement Reasons for MDD Patients Not Receiving Typical or Atypical Antipsychotics
                  • Reimbursement Rate for Selected Antipsychotics in China
                  • Impact of Patient Copayment on Prescribing for Schizophrenia and MDD
                  • Estimated Diagnosis Rate for Schizophrenia and MDD
                  • Estimated Treatment Rate for Schizophrenia and MDD
                  • Percentage of MDD Patients Who Fail to Receive Treatment Because of Lack of Trained Personnel and Equipment
                  • Patient Share of Typical Antipsychotics Among Schizophrenia patients
                  • Reasons to Prescribe Typical Antipsychotics to Schizophrenia Patients
                  • Patient Share of Atypical Antipsychotics Among Schizophrenia patients
                  • Brand Share of Selected Antipsychotics
                  • Prescribing Drivers of Selected Atypical Antipsychotics for Patients with Schizophrenia
                  • Prescribing Drivers of Clozapine for Patients with Schizophrenia
                  • Prescribing Drivers of Olanzapine for Patients with Schizophrenia
                  • Prescribing Drivers of Risperidone for Patients with Schizophrenia
                  • Reasons to Prescribe More Atypical Antipsychotics than Typical Antipsychotics to Schizophrenia Patients
                  • Cost, Budgetary, and Reimbursement Reasons for Schizophrenia Patients Not Receiving Depot Formulations
                  • Reasons Schizophrenia Patients Forgo Treatment with Antipsychotics
                  • Psychiatrists' Perception of Atypical Antipsychotics in the Treatment of Schizophrenia
                  • Most-Preferred Antipsychotics for the Positive Symptoms of Schizophrenia
                  • Drug Classes Used for the Treatment of Negative and Cognitive Symptoms of Schizophrenia
                  • Most Used Antipsychotics for the Cognitive Symptoms of Schizophrenia
                  • Most Used Antipsychotics for the Negative Symptoms of Schizophrenia
                  • Drivers for Prescribing an Antipsychotic for the Treatment of Negative and Cognitive Symptoms of Schizophrenia
                  • Prescribing of Antipsychotics for the Treatment of Negative and Cognitive Symptoms of Schizophrenia
                  • Physicians' Choice of Treatment for Schizophrenia Without Access Barriers
                  • Physicians' Definition of Treatment-Resistant Depression
                  • Most Used Drug Classes for Treatment-Resistant Depression
                  • Line of Therapy of Adjunctive Treatment for Which Antipsychotic Is Most Commonly Introduced for Treatment-Resistant MDD Patients
                  • Patient Shares for Atypical Antipsychotics for Treatment-Resistant Depression
                  • Prescribing Drivers of Atypical Antipsychotics for Patients with MDD
                  • Prescribing Drivers of Olanzapine for Patients with MDD
                  • Use of ECT in Treatment-Resistant MDD Patients
                  • Use of ECT in combination with Atypical Antipsychotics in Treatment-Resistant MDD Patients
                  • Limitations on the Off-Label Use of Antipsychotics for Major Depressive Disorder
                  • Drivers for Choosing an Antipsychotic for Treatment-Resistant Depression
                  • Physicians' Choice of Antipsychotic Treatment for Major Depressive Disorder Without Access Barriers
                  • Unmet Needs in the Treatment of Schizophrenia and MDD in China
                  • Physicians' Expected Brand Share of Risperdal Consta and Paliperidone Palmitate Among Schizophrenia and MDD Patients in China by 2019
                  • Physicians' Perceptions on Prices of Emerging Atypical Antipsychotics in China
                  • Physicians' Intentions to Prescribe Emerging Atypical Antipsychotics for Schizophrenia Patients Once Available
                  • Physicians' Intentions to Prescribe Emerging Atypical Antipsychotics for MDD Patients Once Available (Off-Label Uses)
                  • Physicians' Rationale to Prescribe Emerging Atypical Antipsychotics to Treat Schizophrenia
                  • Treatment of Schizophrenia Symptoms with Emerging Atypical Antipsychotics
                  • Physicians’ Anticipated Use of Emerging Atypical Antipsychotics for Schizophrenia by Line of Therapy
                  • Physicians' Perceptions on the Replacement of Existing Antipsychotics with Emerging Atypical Antipsychotics for Schizophrenia Patients by End of 2019
                  • Likely Use of Other Antipsychotics as Adjunct Therapies to Emerging Atypical Antipsychotics
                  • Physicians' Reasons for Not Prescribing Emerging Atypical Antipsychotics to Schizophrenia Patients
                  • Most Likely Use of Emerging Atypical Antipsychotics in the Treatment of MDD Patients
                  • Physicians' Intentions on the Use of Emerging Atypical Antipsychotics in Different Lines of Therapy for the Treatment of MDD Patients
                  • Physicians' Perceptions on the Replacement of Existing Antipsychotics with Emerging Atypical Antipsychotics for MDD Patients by the End of 2019
                  • Physicians' Rationale to Prescribe Emerging Atypical Antipsychotics to Treat MDD
                  • Physicians' Reasons for Not Prescribing Emerging Atypical Antipsychotics to MDD Patients
                  • Expected Schizophrenia Patient Share of Antipsychotics in 2019 Upon Launch of Emerging Atypical Antipsychotics, Generic Risperdal Consta Depot Injection, and Paliperidone Palmitate

            Author(s): Michael Yeung, MSc

            Based in DRG’s Hong Kong office, Michael analyses the evolving market access landscape in the Asia-Pacific region, including Australia, China, Japan, South Korea, The Philippines, and Taiwan. Michael is also responsible for market research and sales forecast in China among key therapeutic areas including diabetes.

            Michael previously worked as a health economics and outcome research consultant in Tokyo. Michael completed his Master degree in International Health Policy at London School of Economics and has a degree in Biochemistry from Imperial College London.


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