Insomnia is a highly prevalent condition with obvious indirect economic costs, but payers may not be fully aware of the healthcare cost savings that could result from ensuring patient access to effective insomnia treatment. In recent history, market access factors have not been a major constraint for physicians prescribing pharmacotherapies for the treatment of insomnia, because the majority of drugs in the insomnia market are available as inexpensive generic products. However, marketers of emerging insomnia brands such as Eisai’s Dayvigo (lemborexant) will need to understand how payers view the cost-effectiveness of branded insomnia therapies in order to ensure continued favorable reimbursement.

QUESTIONS ANSWERED

  • How do surveyed payers reimburse available insomnia therapies? What restrictions do they impose on branded products, such as Merck’s dual orexin receptor antagonist (DORA) Belsomra (suvorexant)? How do market access dynamics influence physician prescribing of pharmacotherapies for the treatment of insomnia?
  • How will emerging therapies be reimbursed, especially additional members of the DORA drug class? How valuable is long-term efficacy and safety data in chronic insomnia patients to physicians and payers, given that most insomnia therapies have been approved based on only short-term clinical trials?
  • What actions can marketers and developers of insomnia therapies take to succeed in terms of market access and therefore overall sales or use?

CONTENT HIGHLIGHTS

Geography: United States

Primary Research: Survey of 51 U.S. PCPs and 50 U.S. psychiatrists; Survey of 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs / MDs)

Fingertip formulary: Formulary coverage and restrictions data for insomnia therapies by commercial plans covering approximately 166 million lives nationally and and Medicare Advantage with prescription drug plans (MAPDs) covering almost 15 million lives.

Key Drugs Covered: Belsomra, Silenor, zolpidem, eszopiclone, trazodone, ramelteon, Dayvigo

Content highlights:

Reimbursement and contracting

Access and prescribing

Opportunities and challenges for emerging therapies

Disease-specific special topic

PRODUCT DESCRIPTION

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.

Table of contents

  • Insomnia - Access & Reimbursement - Detailed, Expanded Analysis (US)

Author(s): Natalie Taylor, PhD; Chris Lewis

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.

Chris Lewis serves as primary research manager, U.S. 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 B.A. in communications from California State University, Sacramento.


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