Atopic dermatitis is a high-cost category with an increasing number of therapies that treat the condition. To help stakeholders absorb datapoints and perceptions from all directions and synthesize those insights into a tangible strategy for atopic dermatitis, Zitter Insights surveys a leading panel of pharmacy and therapeutics (P&T) decision makers at payers and integrated delivery networks. The Managed Care Biologics and Injectables Index combines deep payer insights with the industry standard in market access information to produce quarterly reports and insights summaries on leading specialty brands.
Payers with almost two-thirds of Medicare lives said that managing atopic dermatitis was a high priority for them. Commercial payers covering approximately four-fifths of lives and Medicare payers with more than half of lives said they manage branded atopic dermatitis agents aggressively. Payers managing more than half of commercial lives said that atopic dermatitis agents have an average budget impact, while those representing more than half of Medicare lives said the products have a high impact on their budget.
Payers with approximately three-fourths of Medicare lives and those with almost two-thirds of commercial lives said there is moderate unmet need in treating atopic dermatitis. More than one-third of dermatologists said the same, and about the same percentage said there is high unmet need.
In the year prior to the survey, dermatologists said they most frequently prescribed monoclonal antibody Dupixent (dupilumab) from Sanofi Genzyme and Regeneron Pharmaceuticals, Inc., treating more than one-third of patients with it. That agent was followed by Pfizer Inc.’s phosphodiesterase 4 (PDE4) inhibitor Eucrisa (crisaborole) and the calcineurin inhibitors Elidel (pimecrolimus) from Bausch Health Companies Inc. and Protopic (tacrolimus) from Astellas Pharma US, Inc. Least prescribed were steroids Olux-E (clobetasol propionate) from Renaissance Acquisition Holdings, LLC division Prestium Pharma, a drug that has generic versions available, and Verdeso (desonide) from Almirall, S.A.
Eli Lilly and Co. and Incyte’s Olumiant (baricitinib), a Janus kinase (JAK) inhibitor, is awaiting an FDA decision in atopic dermatitis. Almost half of dermatologists said its approval would have some impact on their treatment approach for both current and new atopic dermatitis patients. Payers managing almost half of commercial lives and more than a third of Medicare lives said they expect it will have a moderate impact on their coverage of other atopic dermatitis agents. Commercial payers said that an annualized net price of slightly less than $29,000 would be appropriate, while Medicare payers said $27,000. As of late August 2022, the drug’s annual list price for dosing in rheumatoid arthritis and alopecia areata was a little more than $29,000.
Social Determinants of Health
Medicare payers with three-quarters of lives said they offer greater access to telehealth for their disadvantaged members with atopic dermatitis, slightly more than the payers with almost two-thirds of commercial lives. Respondents with approximately the same percentages of lives said they offer services to support health and medicine literacy. Dermatologists said that socioeconomic status is the top non-medical factor that impacts their atopic dermatitis patients’ access to health care services, followed closely by education and health literacy, and occupation and job security.
Message: “Cibinqo is a new product coming out that is an oral version of Eucrisa — the results thus far have outperformed Eucrisa.”
Payer Thoughts: “Very exciting to see an oral version come out — this is so very important in our overall strategy of limiting compounded, specialty creams or in-office procedure drugs whenever possible.”
Adbry, Others Add to Growing Class of Atopic Dermatitis Biologics
The FDA has approved a handful of drugs to treat atopic dermatitis recently. Among them is LEO Pharma Inc.’s Adbry (tralokinumab-ldrm), an interleukin-13 (IL-13) antagonist. According to a Zitter Insights survey, payers may take a bit of a restrictive approach in managing the drug. And with multiple new biologics approved for the condition and more potential agents coming onto the market, payers may impose more utilization management strategies on the therapeutic class as a whole, say industry experts.
FDA Expands Patient Population for Dupixent
On June 7, 2022, the FDA granted another indication to Sanofi and Regeneron Pharmaceuticals, Inc.’s Dupixent (dupilumab) for the treatment of moderate-to-severe atopic dermatitis in people between the ages of 6 months and 5 years whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. The agency initially approved the subcutaneous injectable on March 28, 2017. The FDA gave the new indication priority review.