Psoriasis is a chronic inflammatory skin disorder that is managed with systemic therapies for moderate to severe patients who fail first-line topical therapies and/or phototherapy. Dermatologists have many years of experience prescribing tumor necrosis factor-alpha (TNF-?) inhibitors, which are effective and are supported by a robust postmarketing safety record for psoriasis and other immune disorders. Physicians have also gained greater comfort prescribing the more recently approved interleukin-12/23 (IL-12/23) inhibitor Stelara (Janssen’s ustekinumab), which poses a threat to the dominance of the TNF-? inhibitors as the entrenched first-line therapies after conventional systemic agents. The treatment landscape for moderate to severe psoriasis is poised for significant expansion with the entry of emerging agents with novel mechanisms of action, most notably, the IL-17 inhibitors (i.e., Novartis’s secukinumab, Eli Lilly’s ixekizumab, Amgen’s brodalumab) and two agents with the advantage of oral administration (Pfizer’s Janus kinase inhibitor Xeljanz [tofacitinib] and Celgene’s phosphodiesterase-4 inhibitor Otezla [apremilast]). Additionally, with biosimilars on the horizon, the uptake of novel agents, some of which are expected to be priced at a premium to marketed therapies, will place greater strain on healthcare budgets, resulting in reimbursement restrictions. This report explores physician and payers attitudes toward the shifting treatment landscape for moderate to severe psoriasis.

Questions Answered in This Report:

  • Explore treatment history and trends in moderate to severe psoriasis as well as market access. What percentage of psoriasis patients have moderate to severe disease; what percentage 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 physician and payer perceptions of emerging therapies for moderate to severe psoriasis. In what line of therapy do surveyed dermatologists anticipate using emerging agents (i.e., IL-17 inhibitors, Otezla, Xeljanz)? What factors will drive or constrain prescribing of emerging agents? What will be the coverage of emerging therapies in commercial and Medicare Advantage plans, and what strategies will surveyed MCOs employ to contain costs? How many IL-17 inhibitors will surveyed payers reimburse, and what factors will be most influential in tier placement?

  • Understand physician and payer expectations regarding future trends in the prescribing and reimbursement of systemic therapies. How will the availability of biosimilar versions of adalimumab (AbbVie/Eisai’s Humira) shape treatment decisions, and what strategies will payers use to encourage use of biosimilars? What is the patient share of current therapies for moderate to severe psoriasis, and what will be the patient share of current and emerging therapies in 2017, according to surveyed dermatologists? What is the anticipated tier placement of current therapies by year-end 2016?

Scope:

Markets covered: United States.

Primary research: Online survey of 101 dermatologists and 30 MCO directors (27 pharmacy directors [PDs] and 3 medical directors [MDs]).

Epidemiology: 2013-2017 diagnosed and drug-treated psoriasis cases in the United States.

Author(s): Bingnan Kang, Ph.D.
Ronnie Yoo, Ph.D.

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