The systemic lupus erythematosus (SLE) therapy market in the United States is largely genericized and off-label. With the exception of GlaxoSmithKline’s Benlysta—which launched in 2011—no new drug has been approved for this indication in almost 60 years. Because Benlysta (IV and SC) is an expensive, branded biologic, access to it is typically restricted by payers. Several therapies are in late-phase development for SLE, including agents targeting a previously underserved subpopulation of SLE patients—active lupus nephritis (LN). This report examines the prescribing and reimbursement environment for Benlysta (IV and SC) and emerging SLE agents in the United States, according to surveyed rheumatologists and MCO PDs / MDs. The content explores how physicians and payers perceive current and emerging SLE therapies and the reimbursement dynamics that will promote or restrict market access to the agents.

QUESTIONS ANSWERED

· What is the extent of MCO coverage of Benlysta and an off-label Rituxan, and how do the coverage policies affect rheumatologists' prescribing of these drugs?

· Will approval of Benlysta for LN affect its coverage on commercial plans? How do rheumatologists perceive Benlysta for LN?

· How do physicians anticipate using treatments in development for moderate to severe nonrenal SLE (e.g., anifrolumab, baricitinib), and how do payers expect to cover these therapies on commercial plans?

· What is the potential reimbursement picture for therapies in development for LN (e.g., voclosporin, obinutuzumab), and where in the treatment algorithm do physicians anticipate using them?

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

  • Systemic Lupus Erythematosus - Access & Reimbursement - Detailed, Expanded Analysis (US)

Author(s): Ajay Puri, MBA; Chris Lewis

Ajay Puri is an Associate Analyst in the Immune and Inflammatory team at Decision Resources Group and works on indications like Ulcerative Colitis, Crohn’s disease, and Systemic Lupus Erythematosus.

He holds a Bachelor’s degree in Pharmacy and has earned his MBA (Pharmaceutical) in marketing from NIPER, Mohali. Prior to joining DRG, Ajay worked as a Knowledge Management Associate (Oncology Vertical) at ZS Associates and worked on strategic projects such as competitive assessment, company and product profiling, conference coverage for clients, client specific newsletters and other business development initiatives.
 

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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