Spotlight on Market Access

Almost 90% of small business owners said the cost of prescription drugs is too high and 63% have an unfavorable view of pharmaceutical companies, according to a recent survey of 1,052 small business owners conducted by the lobbying group Small Business for America’s Future. Among the survey respondents, 66% said the current prescription drug market is in need of a major overhaul and 93% agree that the market needs some changes. Survey respondents supported a variety of solutions to bring down prescription drug costs, with the largest share backing a ceiling for out-of-pocket drug costs for Medicare beneficiaries.

Dupixent (dupilumab), the first biologic approved for atopic dermatitis (AD), hasn’t shaken up treatment of the condition completely even as it steadily gains market share, since the bulk of plans still require patients to try mostly generic topical corticosteroids (TCSs) and topical calcineurin inhibitors (TCIs) first. But more competition could be coming to this category, with the FDA set to consider four new products for AD, including three Janus kinase (JAK) inhibitors.

Prescription drug shopping app GoodRx, Inc.’s 2021 is off to a good start, with strong growth in its first publicly traded quarter yielding enough liquidity for the startup to purchase one of its competitors, RxSaver, for $50 million in cash. Experts say the deal and the company’s strong results are proof that it is here to stay, regardless of how retail giants like CVS Health Corp. and Amazon.com Inc. try to shake up the prescription drug market.

MMIT’s latest product release, Launch Coverage Analytics, is now available. Launch Coverage Analytics builds on MMIT’s industry-leading Analytics platform with a targeted solution for pharma companies that are in the first six months of a drug launch and are looking for a way to track key access changes on a weekly basis.

The FDA in February accepted a New Drug Application under priority review for Incyte Corp.’s ruxolitinib cream for the treatment of atopic dermatitis. Meanwhile, there are currently more than 10 agents in Phase III trials for this indication. Among the medications that are on the market, Sanofi and Regeneron’s Dupixent (dupilumab) and Pfizer Inc.’s Eucrisa (crisaborole) are competing for preferred status after topical corticosteroids, topical calcineurin inhibitors and phototherapy. Most medications are covered under the pharmacy benefit, with the exception of Dupixent. More than half of payer pharmacy benefit formularies do not require step therapy or prior authorization for atopic dermatitis medications.

Founded by a physician in 1980 as a primary care clinic for low-income Californians, Molina Healthcare is now the fourth-largest Medicaid insurer in the U.S., serving more than 4.1 million lives. In addition to its public-sector products, Molina also offers Affordable Care Act exchange plans in 12 states. After receiving a contract extension in 2019, CVS Caremark will continue to serve as the insurer's pharmacy benefits manager through 2021, and no plans for a possible successor have been announced.

Change is coming to drug reimbursement under the Medicare and Medicaid programs: CMS is set to implement a new Medicaid rule providing flexibility for value-based drug purchasing and is considering how best to incorporate value-based purchasing into parts of the Medicare program, a panel of experts said recently.

Currently, the federal government is covering the cost of COVID-19 vaccines for all people who live in the U.S. But once the COVID vaccines move from emergency use authorization to full approval, the U.S. is no longer in a public health emergency and the federal government isn’t reimbursing for the vaccines anymore, how will payers manage the COVID vaccines? And how will manufacturers price the vaccines?

Based on invoice price levels, the IQVIA Institute for Human Data Science anticipates that the global medicine market will experience a 3% to 6% compound annual growth rate (CAGR) through 2025. Oncology and immunology are the top two therapy areas globally, and they are expected to grow 9% to 12% CAGR during the same time period, according to the company’s recently released report titled Global Spending and Usage of Medicines: Outlook to 2025.

Industry analysts say they expect the environment for mergers and acquisitions in the health insurance sector to be “favorable” this year, and thus they anticipate “robust M&A activity” among firms that are eager to diversify their assets and modernize their technology.