Myelodysplastic syndromes (MDS) are a heterogeneous collection of hematopoietic stem cell disorders that result in cytopenias. Based on our survey results, the U.S. reimbursement environment already restricts the prescription of high-priced MDS medications, and treatment costs are set to increase with the expected approval of new agents, including BristolMyers Squibb / Acceleron’s Reblozyl. In this report, we analyze in depth the current and anticipated uptake of MDS therapies. In addition, we examine how MCO formulary decisions and utilization controls on both the pharmacy benefit and medical benefit affect the prescribing of surveyed hematologists.
- What is the coverage status of key MDS medications such as Vidaza, Revlimid, and the ESAs? What are the key drivers of their status?
- How strong of an impact do reimbursement restrictions have on hematologists’ decision to use less-effective but more-affordable treatment options for MDS? What other factors influence prescribing?
- Which are the key factors that payers consider before including a drug in their formulary? What changes do payers anticipate in the future?
- What attributes must an emerging MDS therapy offer to secure favorable coverage and formulary positioning? What impact will luspatercept’s potential approval have on the MDS therapy market?
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.
Release date: June 2020
Geography: United States
Primary research: Survey of 100 U.S. hematologists and 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs / MDs).
Fingertip formulary: Formulary coverage and restrictions data for MDS therapies by commercial plans covering approximately 166 million lives and Medicare Part D plans covering 35 million lives nationally.
Key drugs covered: Vidaza, Revlimid, Dacogen, Epogen, Aranesp, Procrit
Key analysis provided:
- Reimbursement and contracting.
- Access and prescribing.
- Opportunities and challenges for emerging therapies.
- Disease-specific special topic.
- Myelodysplastic Syndromes - Access & Reimbursement - Detailed, Expanded Analysis (US)
Author(s): Rachit Singhal, M.Pharm; Chris Lewis
Rachit Singhal is an analyst in the Infectious, Niche, & Rare Diseases (INRD) team at Decision Resources. In this role he works on GVHD and hematologic malignancy reports. He has an experience of more than 4 years in multi facets of healthcare analytics such as digital analytics as well as IQVIA’s proprietary MIDAS data-based analytics. He also has experience in stakeholder management, client liaising and product management.
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.