Zitter Pulse Check: Multiple Sclerosis

Coverage

Multiple sclerosis (MS) 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 MS, 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

When commercial payers were asked about what factors influenced their management of biologic therapies in MS, the top characteristic was a drug’s efficacy, followed closely by its safety/ tolerability and cost (see chart). Half of the respondents said they would like manufacturers to discuss cost and efficacy of MS agents. Least influential were manufacturer-provided patient education services and manufacturerprovided physician education services. Payers moderately manage the MS class but anticipate that their management aggressiveness will increase slightly in 2022. Some tactics they expect to utilize include more preferred product usage, including preferring more generic and biosimilar therapies, and an increase in formulary exclusions.

Key Findings

Ideal Therapies

About one-quarter of neurologists said that Biogen’s Tecfidera (dimethyl fumarate) and Copaxone (glatiramer acetate) from Teva Pharmaceutical Industries Ltd. are their ideal first-line therapies. Those were followed by Ocrevus (ocrelizumab) from Roche Group member Genentech USA, Inc. and Gilenya (fingolimod) from Novartis Pharmaceuticals Corp. Among second-line therapies, neurologists again ranked Tecfidera most ideal, followed by Ocrevus. Biogen’s Tysabri (natalizumab) and Copaxone.

Ponvory

On March 19, 2021, the FDA approved the Janssen Pharmaceutical Companies of Johnson & Johnson’s Ponvory (ponesimod) to treat adults with relapsing forms of MS. The approval was based in part on the Phase III OPTIMUM study, which showed the product reduced annual relapses by 30.5%, compared with Sanofi’s Aubagio (teriflunomide). Almost two-thirds of neurologists said they are likely to prescribe Ponvory over select MS drugs (see chart), with Aubagio the top therapy that they would prescribe Ponvory over.

Contracting

Payers with almost three-fourths of covered lives said that Gilenya is their top oral MS drug for which they are likely to pursue first-line contracting. Among the intravenous therapies, Novartis’ Kesimpta (ofatumumab) was the top agent, while Glatopa (glatiramer acetate) — a generic of Copaxone — from Sandoz, a Novartis Pharmaceuticals Corp. division, was the No. 1 subcutaneous therapy for first-line contracting, favored by payers covering more than half of lives.

Trends

Treatment Duration

Message: “The representative introduced Mavenclad, and its unique mechanism of action. According to their introduction, this medication will likely only need to be used for two cycles and may not need any therapy for up to 4 years.”

Payer Thoughts: “From the payer standpoint, if you’re going to bring me a medication that is priced so that it is essentially getting 3-4 years of equivalent value in these two cycles, then offer me something in return. If I spend $200k on a new car, they give me a warranty. Give me a guarantee that no other therapy will be needed for 4 years, or YOU can pay for it. I’ve heard many claims of ‘you won’t need to re-treat’ already with another product. That hasn’t held up there, and I’m not sold here either. Give me a guarantee, and I’ll consider your data more reliable.”

Pilot Targets SDOH Barriers for People With MS

Recognizing the impact that social determinants of health can have, AllianceRx Walgreens Prime is partnering with Highmark Inc. to launch a pilot outreach program focused on the impact of SDOH on people with multiple sclerosis.

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

Study Finds Good Adherence With Oral DMTs

The multiple sclerosis (MS) therapeutic class boasts more than 20 disease modifying therapies (DMTs) that have various routes of administration. A recent study of oral therapies to treat relapsing-remitting MS found that they are well tolerated, have high adherence rates and have low rates of adverse events.

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

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