Market Outlook

Atypical antipsychotics—the cornerstone of schizophrenia treatment—are available as oral and long-acting depot formulations in the United States. Many of the oral atypical antipsychotic therapies used to treat the symptoms of schizophrenia are generically available, potentially creating barriers to access for branded oral agents (e.g., Sunovion’s Latuda, Otsuka/Lundbeck’s Rexulti, Allergan’s Vraylar). Newer depot formulations of atypical antipsychotics (e.g., Alkermes’s Aristada, Janssen’s Invega Trinza) offer the possibility of better patient compliance, although access to these therapies also may be restricted due to their high cost relative to other agents. With a wide variety of antipsychotic therapy options available, novel oral schizophrenia therapies will be entering a crowded and highly genericized market and may face reimbursement difficulties.

Questions Answered

  • How do payer policies affect the prescribing of branded oral atypical antipsychotics (e.g., Latuda, Rexulti, Vraylar) and depot atypical antipsychotics (e.g., Otsuka/Lundbeck’s Abilify Maintena, Janssen’s Risperdal Consta) in this genericized market?
  • What do payers report as the coverage status of branded oral and depot atypical antipsychotics on Medicaid and commercial plans? Is automatic generic substitution employed for oral therapies that are generically available?
  • What are the preferred pharmacoeconomic models for payers when evaluating new schizophrenia therapies, and what types of pharmacoeconomic data do they find most compelling?
  • How do payers anticipate including emerging oral schizophrenia therapies on formularies at various price points, and how do psychiatrists expect to incorporate them in the treatment of schizophrenia patients?

Product Description

Access & Reimbursement: Provides in-depth insight regarding the impact of payer policy on physician prescribing behavior so you can build your market access strategy and optimize your brand positioning.

Table of contents

  • Schizophrenia - Access & Reimbursement - Detailed, Expanded Analysis (US)
    • Market Access Overview
      • Actionable Recommendations to Optimize Market Access
        • Successes and Stumbles
          • Overview of Successes and Stumbles for Schizophrenia
          • Successes Among Schizophrenia Therapies in the United States: Physicians
          • Stumbles Among Schizophrenia Therapies in the United States: Physicians
          • Successes Among Schizophrenia Therapies in the United States: MCOs
          • Stumbles Among Schizophrenia Therapies in the United States: MCOs
          • Best-Performing Depot Schizophrenia Drug in Terms of Market Access Themes: Psychiatrists
          • Best-Performing Depot Schizophrenia Drug Overall in Terms of Market Access: Psychiatrists
          • Best-Performing Oral Schizophrenia Drug in Terms of Market Access Themes: Psychiatrists
          • Best-Performing Oral Schizophrenia Drug Overall in Terms of Market Access: Psychiatrists
        • Key Stakeholders in the Road to Market Access
          • Stakeholder Influence on Physician Prescribing
          • United States: Stakeholder Dynamics in the Road to Reimbursement
          • Healthcare Coverage in the United States
          • Healthcare Coverage in the United States
          • Major Commercial Insurers in the United States
        • Key Market Access Roadblocks
          • Reimbursement Dynamics
            • United States: Commercial Managed Care Organizations
              • Lessons Learned and Key Takeaways
              • Current Reimbursement of Key Branded Depot Schizophrenia Drugs on MCOs' Medicaid Plans
              • Current Reimbursement of Key Branded Oral Schizophrenia Drugs on MCOs' Medicaid Plans
              • Current Reimbursement of Key Branded Depot Schizophrenia Drugs on MCOs' Commercial Plans
              • Current Reimbursement of Key Branded Oral Schizophrenia Drugs on MCOs' Commercial Plans
              • Anticipated Reimbursement of Key Branded Depot Schizophrenia Drugs in 12 Months' Time: MCOs' Commercial Plans
              • Anticipated Reimbursement of Key Branded Oral Schizophrenia Drugs in 12 Months' Time: MCOs' Commercial Plans
              • Preferred Comparator Drugs for Emerging Schizophrenia Therapies
              • Pricing and Reimbursement Drivers
              • Key Findings: P&R
              • Drivers of Reimbursement/Formulary Placement of Schizophrenia Drugs on Commercial Plans
              • Value Assessment and Pharmacoeconomics
              • Preferred Pharmacoeconomic Assessment for Schizophrenia Therapies in MCOs' Commercial Plans
              • PE/HE Data Viewed as Most Compelling for a Schizophrenia Therapy
              • Cost-Sharing for Key Therapies Treating Schizophrenia
              • Copay and Coinsurance Rates for Depot Therapies Treating Schizophrenia
              • Copay and Coinsurance Rates for Oral Therapies Treating Schizophrenia
              • Restrictions Affecting Treatment of Schizophrenia
              • Restrictions Used in Commercial Plans
              • Average Coinsurance for Key Depot Schizophrenia Therapies Covered Under Specialty or Non-Specialty Tiers in MCOs' Commercial Plans
              • Average Copayment for Key Depot Schizophrenia Therapies Covered Under Specialty or Non-Specialty Tiers in MCOs' Commercial Plans
              • Average Coinsurance for Key Oral Schizophrenia Therapies Covered Under Specialty or Non-Specialty Tiers in MCOs' Commercial Plans
              • Average Copayment for Key Oral Schizophrenia Therapies Covered Under Specialty or Non-Specialty Tiers in MCOs' Commercial Plans
              • Average Deductible Charged for Branded Schizophrenia Therapies Under MCOs' Commercial Plans
          • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
            • Patient Share in Key Payer Channel
              • Key Findings
              • Prescription-Drug-Treatment Rate in Diagnosed Schizophrenia Patients
              • Schizophrenia Patients by Symptom Domain
              • Patient Share for Schizophrenia Among Commercially Insured and Medicaid Covered Patients
              • Treatment Decision Drivers
              • Factors Affecting Psychiatrists' Choice of Therapy for the Treatment of Schizophrenia
            • Prescriber Preference
              • Prescriber Preferences for Schizophrenia
              • Prescribing vs. Preference for Depot Formulations
              • Prescribing vs. Preference for Branded Oral Formulations
            • Impact of Restrictions on Prescribing
              • Payer Policy Impact on Prescribing: Key Findings
              • Physician-Reported Cost-Control Measures on Branded Schizophrenia Therapies
          • Market Access Landscape for Emerging Therapies
            • Impact of Emerging Therapies on Prescribing
              • Likely Impact of Emerging Therapies for Schizophrenia
              • Patient Share for Therapies If Emerging Agents Are on Preferred vs. Nonpreferred Tier
            • Potential Placement of Emerging Therapies at Various Prices
              • Potential Reimbursement of Emerging Therapies for Schizophrenia
              • Potential Formulary Tier Placement of ALKS-3831 at Various Price Points
              • Potential Formulary Tier Placement of MIN-101 at Various Price Points
              • Potential Formulary Tier Placement of Lumateperone at Various Price Points
            • Prescriber and MCO Priorities for Emerging Therapy Evaluation
              • Key Findings
              • Areas for Future Opportunity for Schizophrenia: Psychiatrists
              • Areas for Future Opportunity for Schizophrenia: MCOs
              • Emerging Therapies with the Greatest Impact on the Treatment of Schizophrenia
          • Methodology
            • Primary Market Research Methodology: Physicians
              • Average Years in Clinical Practice
              • Average Number of Schizophrenia Patients Treated Per Month
              • Psychiatrists' Practice Location by Region
              • Psychiatrists' Practice Location by State
              • Schizophrenia Patients by Insurance Type
              • Types of Antipsychotics Prescribed by Psychiatrists
            • Primary Market Research Methodology: MCOs
              • Percentage of MCO PDs/MDs
              • Distribution of MCO PDs/MDs by Region
              • Distribution of MCO PDs/MDs by State
              • Operation of MCOs
              • Types of Insurance Plans Offered by MCOs
              • Distribution of Covered Lives
              • Average Number of Covered Lives
              • MCO PDs/MDs' Familiarity with Coverage Details of Atypical Antipsychotics
              • Formulary Tier Structure of MCO Commercial Plans
          • Appendix
            • Physician Survey
              • Surveyed Psychiatrists by Practice Location
              • Percentage of Treatment-Resistant Schizophrenia Patients
              • Percentage of Treatment-Resistant Schizophrenia Patients by Residual Symptom Type
              • Best-Performing Depot Schizophrenia Drug in Terms of Clinical Attributes: Psychiatrists
              • Best-Performing Oral Schizophrenia Drug in Terms of Clinical Attributes: Psychiatrists
              • Factors Affecting Psychiatrists' Prescribing Decisions for Schizophrenia: Depot Antipsychotics
              • Factors Affecting Psychiatrists' Prescribing Decisions: Oral Antipsychotics
              • Importance of Out-of-Pocket Costs in Prescribing Decisions for Schizophrenia
              • Psychiatrists' Treatment of Negative Symptoms and CIAS
              • Most Common Drug Classes Used to Treat CIAS
              • Most Common Drug Classes Used to Treat Negative Symptoms of Schizophrenia
              • Reasons Diagnosed Schizophrenia Patients Do Not Receive Prescription Drug Treatment
              • Reasons for Not Treating Negative Symptoms of Schizophrenia or CIAS
              • Access and Reimbursement Hurdles Under Medicaid Plans and Impact on Prescribing of Depot Schizophrenia Therapies
              • Access and Reimbursement Hurdles Under Medicaid Plans and Impact on Prescribing of Oral Schizophrenia Therapies
              • Access and Reimbursement Hurdles Under Commercial Plans and Impact on Prescribing of Depot Schizophrenia Therapies
              • Diagnosed and Drug-Treated Schizophrenia Patients by Symptom Type
              • Access and Reimbursement Hurdles Under Commercial Plans and Impact on Prescribing of Oral Schizophrenia Therapies
              • Approval of Vraylar for Negative Symptoms of Schizophrenia
              • Impact of Potential Approval of Vraylar for Negative Symptoms of Schizophrenia on Prescribing
              • Maximum Expected Patient Share for ALKS-3831 in Schizophrenia
              • Maximum Expected Patient Share for MIN-101 in Schizophrenia
              • Current Schizophrenia Therapies Most Likely to Be Replaced by Emerging Therapies
              • Maximum Expected Patient Share for Lumateperone in Schizophrenia
              • Anticipated Use of Emerging Schizophrenia Therapies by Patient Type
            • MCO Survey
              • Impact of Approval for Negative Symptoms of Schizophrenia on Reimbursement of Vraylar
              • Degree of Customization of PBM Formulary in MCOs' Commercial Plans
              • MCO P&T Committee Members with the Most Influence on Formulary Decisions for Schizophrenia
              • Information Required for Formulary Review of Schizophrenia Drugs by MCO P&T Committee
              • Estimated Time Between New Product Launch and P&T Committee Review and Decisions on Utilization Management Criteria
              • Interim Coverage Status of Schizophrenia Drugs Following FDA Approval Before Formulary Review
              • Inclusion of Schizophrenia Drugs on Medicaid MCO Contract
              • MCOs' Perceived Performance of Depot Schizophrenia Therapies on Pricing and Reimbursement Drivers
              • MCOs' Perceived Performance of Oral Schizophrenia Therapies on Pricing and Reimbursement Drivers
              • Cost-Control Approaches for Key Depot Schizophrenia Therapies in MCOs' Commercial Plans
              • Cost-Control Approaches for Key Oral Schizophrenia Therapies in MCOs' Commercial Plans
              • Prior Authorization Requirement for Key Depot Schizophrenia Therapies on MCOs’ Commercial Plans
              • Prior Authorization Requirement for Key Branded Schizophrenia Therapies in MCOs' Commercial Plans
              • Step Therapy Requirement for Key Oral Schizophrenia Therapies in MCOs' Commercial Plans
              • Step Therapy Requirement for Key Oral Schizophrenia Therapies in MCOs' Commercial Plans
              • Stabilization Requirement for Key Depot Schizophrenia Therapies in MCOs' Commercial Plans
              • Number of Steps Required in Step Therapy Protocols for Key Depot Schizophrenia Therapies in MCOs' Commercial Plans
              • Mandatory Generic Substitution of Oral Antipsychotics in MCOs' Commercial Plans
              • Mandatory Generic Substitution of Oral Antipsychotics by Brand in MCOs' Commercial Plans
              • Contracting Agreements in Place for Key Depot Schizophrenia Therapies on MCOs' Commercial Plans
              • Delegation of Responsibility for Formulary Development and Contracting With Pharmaceutical Manufacturers for MCOs' Commercial Plans
              • PBM Formulary Used by MCOs' Commercial Plans
              • Contracting Agreements in Place for Key Oral Schizophrenia Therapies on MCOs' Commercial Plans
              • Deductible Charges for Branded Schizophrenia Therapies Under MCOs' Commercial Plans
            • About Decision Resources Group
              • Natalie Taylor
          • Key Abbreviations Related to Schizophrenia
          • Bibliography

        Author(s): Natalie Taylor, PhD

        Natalie Taylor, Ph.D. is a Principal Business Insights Analyst with the central nervous system/ophthalmology disorders team at Decision Resources Group. She has over ten years of experience authoring primary and market research reports for pharmaceutical industry clients across multiple psychiatry, pain, neurology, and ophthalmology therapy areas.

        Prior to joining DRG, Dr. Taylor worked at QuintilesIMS as manager of the central nervous system portfolio of Disease Insights market forecasting offerings. She completed her Ph.D. in Physiology at Dartmouth College in Hanover, New Hampshire, where she studied the role of serotonergic neurons in the medullary raphe on modulating respiratory responses in mammals. She holds a B.S. in Biology from Dickinson College in Carlisle, Pennsylvania.


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