Zitter Pulse Check: Atopic Dermatitis (August 2023)

Coverage

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.

Payer Management

Payers with almost three-fifths of commercial lives said that managing branded treatments for atopic dermatitis was a high priority for them. Payers with more than two-thirds of commercial lives and almost three-fourths of Medicare beneficiaries expressed average satisfaction with current drugs to treat the condition. Commercial payers covering two-fifths of lives and Medicare payers with more than one-third of lives said they manage branded atopic dermatitis agents aggressively.

Payers with two-thirds of commercial beneficiaries, those with almost three-quarters of Medicare lives and more than half of dermatologists said there is moderate unmet need in the treatment of atopic dermatitis.

Key Findings

Manufacturer Ratings

Payers, dermatologists and practice managers were asked to rate manufacturers of atopic dermatitis medications on six different metrics: overall commitment to the disease, account representative support, patient/family support resources, patient copay assistance, physician education/support and hub services. Payers said that Pfizer Inc. was the best in both overall commitment to the disease and physician education and support. They cited AbbVie Inc. as the No. 1 company in patient copay assistance, while selecting Sanofi for the top ranking in account representative support, patient/family support and hub services. Dermatologists said AbbVie was best in overall commitment to the disease and account representative support, Sanofi top in patient/family support services, and Pfizer No. 1 in the other three categories. Practice managers said Pfizer was best in account representative support, AbbVie was No. 1 in patient/family support resources, and Sanofi top in the remaining four metrics.

Lebrikizumab

Eli Lilly and Co. is investigating lebrikizumab, an interleukin-13 (IL-13) inhibitor, for use in people at least 12 years of age with moderate-to-severe atopic dermatitis. The drug is in Phase III trials, and the company said it expects an FDA decision on the agent by the end of 2023. Payers with almost two-fifths of commercial lives, those with more than half of Medicare beneficiaries and almost one-fifth of dermatologists said they are somewhat aware of the drug. Payers said that an annualized net price between $31,000 and $33,000 would be appropriate. Two-fifths of dermatologists expect the drug will have a moderate impact on their treatment approach to the condition, expecting that it will change their approach to treatment for a considerable portion of their current patients. Payers with approximately half of lives also said they expect lebrikizumab to have a moderate impact on other atopic dermatitis agents, meaning that some products may see a change in tiering and/or utilization management criteria.

Social Determinants of Health

The top social determinants of health initiative that commercial payers offer for their disadvantaged members with atopic dermatitis is greater access to telehealth, followed by services to support health and medicine literacy and resources to assist in health/medicine language barriers. Greater access to telehealth also was the top initiative among payers covering Medicare beneficiaries, followed by providing transportation to and from medical appointments, services to support health and medicine literacy and resources to assist in health/medicine language barriers. 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.

Trends

Product Dosing

Message: “We were presented with a budget impact model on the use of Adbry [(tralokinumab-ldrm) from LEO Pharma, Inc.] for our member base. The data was based off the ECZTRA 3 Trial design with every-four-week dosing after 16 weeks of every-two-week dosing. Per the design, about 33% of the patients would be eligible for an EVERY-FOUR-WEEK dosing. Others in the market currently don’t have an every-four-week dosing schedule.”

Payer Thoughts: “Data shows an every-four-week dosing option as a valuable way for the health plan and member to save on treatment. We would structure a PA to be good through every 16 weeks so the patient is evaluated for the every-four-week dosing. We will need to allow an every-two-week dosing, however, if the reduced frequency is not effective.”

Optum Rx ‘Pipeline’ Report Takes Closer Look at Three Large-Population Drugs

In its latest drug pipeline insights report, Optum Rx pivots from its habit of highlighting upcoming medications for rare diseases, instead focusing on a trio of emerging therapies that target much wider patient populations. The UnitedHealth Group-owned PBM tells AIS Health, a division of MMIT, that the move was driven more by happenstance than intention.

In its report, Optum Rx focuses on zuranolone, a Biogen/Sage Therapeutics-developed treatment for adults with major depressive disorder and postpartum depression; Zimura (avacincaptad pegol) from IVERIC Bio, which targets an eye disease known as geographic atrophy; and Eli Lilly & Co.’s lebrikizumab, which will treat adults and adolescents with moderate-to-severe atopic dermatitis.

Subscribers to AIS’s RADAR on Drug Benefits may read the in-depth article online

FDA Expands Patient Population for Cibinqo

On Feb. 9, 2023, the FDA expanded the patient population of Pfizer Inc.’s Cibinqo (abrocitinib) to include the treatment of people at least 12 years old and less than 18 with refractory, moderate-to-severe atopic dermatitis whose disease is not adequately controlled with other systemic drug products, including biologics, or when use of those therapies is not advised. The agency initially approved the Janus kinase (JAK) inhibitor on Jan. 14, 2022. Dosing of the tablet is 100 mg once daily. The drug’s price for 30 tablets of all three strengths — 50 mg, 100 mg and 200 mg — is $4,914.

Subscribers to AIS’s RADAR on Specialty Pharmacy may read the in-depth article online

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