Crohn’s disease 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 Crohn’s, 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.
Commercial payers with almost three-fourths of covered lives say that AbbVie Inc.’s Humira (adalimumab) is their ideal first-line therapy, with many citing its relatively low cost (see chart). Payers with more than one-third of lives say that Takeda Pharmaceutical Company Limited’s Entyvio (vedolizumab) and Stelara (ustekinumab) from Johnson & Johnson subsidiary Janssen Biotech, Inc. are the top second-line drugs. Humira and Renflexis (infliximab-abda), a biosimilar of Janssen’s Remicade (infliximab), are the most ideal third-line treatments.
More than one-third of gastroenterologists say Humira is their most ideal therapy due to its ease of use and long-time availability, followed closely by Remicade. For second-line treatments, Remicade is No. 1, followed by Entyvio. Almost half cite Stelara as their No. 1 third-line therapy, and more than one-third say Entyvio.
In February 2020, Janssen released interim data from the Phase IIIb STARDUST study that showed 79% of people with moderately to severely active Crohn’s achieved clinical response at week 16, and 67% were in clinical remission after two doses. While payers with almost all covered lives said they would not change their management of the drug, more than half of gastroenterologists said those data would prompt them to change their prescribing habits for the drug. The most likely action was prescribing Stelara over other Crohn’s treatments (see chart).
Entyvio is available as an intravenous infusion, but Takeda is conducting clinical trials of it as a subcutaneous injection. If the FDA approves the subcutaneous formulation, payers with almost half of covered lives say they are likely to use that to negotiate better rebates for the drug. Those with almost three-fourths of lives are unlikely to prefer Entyvio over other Crohn’s therapies, but almost half of gastroenterologists say they are likely to prescribe Entyvio over other Crohn’s treatments.
Payers with almost three-fourths of covered lives have not seen site-of-care shifts for the administration of Crohn’s therapies due to the COVID-19 pandemic. Of those that have seen a change, more than half have seen treatments move to self-administration in a patient’s home. Gastroenterologists have experienced reduced patient volume and delayed infusions. Some have transitioned patients from intravenous treatments to oral and subcutaneous therapies.
Pricing & Rebates
Message: “Inflectra’s cost structure is changing to be more preferred than Janssen’s offerings. Pfizer is anticipating 10% increased market share with Crohn’s treatment as prescribers and patients are inclined to use Inflectra over Remicade. More transparent pricing and rebates to allow increased value of therapy over competitors.”
Payer Thoughts: “The pricing and rebate landscape is facing increased regulatory and payer drive for transparency. More emphasis is being placed on product pricing vs. rebates due to regulatory and payer pressure.”
Integrated Claims Give Full View of AI Class
Some companies that analyze specialty drug spend do so with a focus solely on the pharmacy benefit. This approach, however, may fail to take into account a significant amount of medical benefit spending within certain conditions, including inflammatory diseases. A recent study by Prime Therapeutics LLC revealed trends across both benefits for the conditions.
Indication-Based Formularies Are Growing in Use
The anti-inflammatory therapeutic class consistently ranks at the top of the costliest specialty classes in the pharmacy benefit, prompting payers to try new management strategies. A few years ago, some payers began offering indication-specific formularies within the class, and the strategy continues to gain traction.