Numerous drugs from multiple drug classes are used as monotherapies and/or adjunctive therapies for the treatment of major depressive disorder (MDD). The MDD treatment armamentarium is becoming increasingly genericized, a trend that has improved patient access to antidepressants, as well as eased restrictions on off-label adjunctive use of atypical antipsychotics. At the same time, the expanding presence of generic drugs has given payers more leverage to control drug treatment costs in MDD. Understanding the current and expected influence of clinical metrics and value-for-dollar on market access and medical practice is key for developers of new therapies for MDD.


  • In this mature and highly generic treatment landscape, what actions can marketers of MDD therapies taketo gain market access and thus ensure uptake?
  • How do payer policies affect the prescribing of branded oral atypical antipsychotics (e.g., Lundbeck/Otsuka Pharmaceutical’s Rexulti, Allergan’s Vraylar) and antidepressants (e.g., Lundbeck/Takeda’s Trintellix, Allergan’s Viibryd) in this genericized market?
  • To which of their MDD patients do physicians anticipate prescribing the emerging therapies esketamine (Janssen), gepirone ER (Fabre-Kramer), and rapastinel (Allergan)? How do payers expect to reimburse these 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.

Markets covered: United States

Primary research: Survey of 50 U.S. primary care physicians, 50 U.S. psychiatrists, and 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs) fielded in January 2019.

Key companies: Allergan, Eli Lilly, Fabre-Kramer Pharmaceuticals, Janssen, Lundbeck, Otsuka, Sunovion, Takeda,

Key drugs: Duloxetine (Cymbalta, generics), Latuda, Rexulti, Trintellix, Viibryd, Vraylar, esketamine, gepirone ER, rapastinel

Content highlights:

  • Reimbursement and contracting
  • Access and prescribing
  • Special topics
  • Opportunities and challenges for emerging therapies

Table of contents

  • Unipolar Depression - Access & Reimbursement - Detailed, Expanded Analysis (US) Major Depressive Disorder
    • Access & Reimbursement Major Depressive Disorder US June 2019

Author(s): Lisa Cloonan, BA; Andrea Witt, PhD; Audreza Das, P.G. Dip.

Lisa joined Decision Resources Group in 2015 as a business insights analyst for the Central Nervous System and Ophthalmology division. In this role, she analyzes the commercial opportunities for pharmacological therapies across the psychiatry space.

Prior to joining Decision Resources Group, Lisa spent 6 years in clinical stroke research at Massachusetts General Hospital. While in the clinical research field, Lisa developed an expertise in neuroimaging analysis, as well as authored and co-authored articles on the influence of white matter hyperintensity burden on stroke risk and recovery. Lisa holds bachelor of arts from Connecticut College, where her course work focused on behavioral neuroscience.

Andrea S. Witt, Ph.D., is Therapy Leader of the Central Nervous System and Ophthalmology Disorders Portfolio at Decision Resources Group where she oversees a team of 14 Business Insights Analysts and Senior Directors responsible for market research encompassing Neurology, Psychiatry, Pain, and Ophthalmology.

 Dr. Witt has been with Decision Resources Group for over 12 years, following CNS markets and trends. Her interests beyond specific CNS indications included the market potential for neuroprotectants and the impact of biomarkers on CNS markets. Dr. Witt’s research, analysis, and commentaries have appeared in Barron’s, Pharmaceutical Executive, PharmaVoice, Nature Medicine, and CNBC. Dr. Witt’s previous experience includes 10 years of scientific research conducted on neurodegenerative disorders at Harvard Medical School/Brigham and Women’s Hospital, Duke University, and the University of Texas-Southwestern Medical Center, where she earned her Ph.D. degree.

Audreza Das is a Senior Analyst in the CNS/Ophthalmology team at Decision Resources Group

She has authored content across indications, including neuropathic pain, age-related macular degeneration, treatment-related depression, painful diabetic neuropathy, and migraine. Ms. Das has previously worked at Novo Nordisk, as a Market Analyst for European markets. Previous experience at a SME, included developing disease competitive landscapes, covering global conferences etc. Ms. Das received her B.E. degree in Biotechnology from Birla Institute of Technology, a deemed university and her P.G. Diploma in Cancer Immunology & Biotechnology from University of Nottingham.

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