Physician and Payer Receptivity to Novel Oral and Biologic Agents vs. Biosimilars - A Survey of Dermatologists and Managed Care Organization Pharmacy and Medical Directors

For many years, dermatologists have relied upon tumor necrosis factor-alpha (TNF-α) inhibitors and conventional systemic treatments to treat patients with moderate to severe forms of the inflammatory skin disease psoriasis. Dermatologists now also have considerable experience with the IL-12/23 inhibitor Stelara, which threatens the position of TNF-α inhibitors as the mainstay of biologic treatment in psoriasis. The end of 2014 and beginning of 2015 saw the launch of two new agents, further altering the landscape of psoriasis treatment: Cosentyx (Novartis’s secukinumab) features a novel mechanism of action, with demonstrated superiority over both Stelara and the TNF-α inhibitor Enbrel (Amgen/Pfizer’s etanercept), and Otezla (Celgene’s apremilast) is the first new class of oral treatment approved for psoriasis in nearly 20 years. The next three years will bring further change, with the likely approval of an additional oral therapy, Xeljanz (Pfizer’s tofacitinib), two new IL-17 inhibitors (Eli Lilly’s ixekizumab and AstraZeneca’s brodalumab), and the introduction of biosimilar adalimumab to the U.S. market. This report examines the current practice and preferences of prescribing physicians and payers, and their attitudes and expectations about how these events will shape the treatment and reimbursement landscape for moderate to severe psoriasis.

Questions Answered in This Report:

  • Explore treatment history and current trends in treatment of moderate to severe psoriasis as well as market access. What percentage of moderate to severe psoriasis patients fail conventional systemic agents and are candidates for biologic therapy? What are the most common treatment histories of patients receiving biologics? What factors constrain prescribing of Stelara? What cost controls are in place for marketed therapies, and how do differences in reimbursement restrictions impact dermatologists’ prescribing of biologics?

  • Understand and anticipate physicians’’ and payers’ sentiment toward IL-17 inhibitors. How would a warning label for brodalumab affect physicians’ and payers’ perception of both brodalumab and other IL-17 inhibitors? What percentage of physicians is already treating patients with the first-in-class IL-17 inhibitor Cosentyx, and where in the treatment algorithm are they using it? What are payers’ and physicians’ opinions about the current and future reimbursement environment for Cosentyx and subsequent IL-17 inhibitors when these launch? Will the approval of additional IL-17 inhibitors impact reimbursement of Cosentyx?

  • Understand physicians’ current use and experience with Otezla. Where in the treatment algorithm are physicians using Otezla? What current therapies are most at risk of being replaced by Otezla? What changes do physicians and payers expect for the reimbursement environment of Otezla?

  • Understand physician and payer expectations for prescribing and reimbursement trends in psoriasis over the next three years. How will the availability of biosimilar adalimumab change the use and tier positioning of TNF-α inhibitors? Will the availability of novel oral therapies affect the use of biologics? In 2018, what do dermatologists forecast will be the patient shares of both current and emerging therapies? What is the anticipated tier placement of current therapies by year-end 2017, according to surveyed MCO PD/MDs?


Markets covered: United States.

Primary research: Online survey of 101 dermatologists and 30 MCO directors (19 pharmacy directors and 11 medical directors).

Epidemiology: 2014-2018 diagnosed and drug-treated psoriasis cases in the United States.

Emerging therapies: Phase II: 2 drugs; Phase III: 2 drugs; registered: 1 drugs.

Author(s): Brian Nasipak

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