Psoriasis 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 psoriasis, 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 more one-third of covered commercial lives and those with almost half of Medicare lives said that managing brand drugs for psoriasis is a very high priority. Around one-third of those respondents said that they are somewhat aggressive in their management of the agents. Payers with almost half of commercial lives and approximately half of dermatologists said they are highly satisfied with the current options for treating psoriasis.
More than a third of dermatologists said that there is low or moderate unmet need in treating the condition. More than half of dermatologists and payers with almost two-thirds of commercial lives said there is a high disease burden for people with psoriasis.
On May 23, 2022, the FDA approved Roivant Sciences subsidiary Dermavant Sciences, Inc.’s Vtama (tapinarof) cream for the topical treatment of plaque psoriasis in adults, regardless of disease severity. At the time of the survey, commercial payers with three-fourths of lives and Medicare payers with more than two-thirds of lives had not conducted a pharmacy and therapeutics (P&T) review of the drug. Of those respondents, payers covering more than half of Medicare lives said they were extremely aware of the medication.
As of early August 2022, the FDA had approved seven biosimilars of AbbVie Inc.’s Humira (adalimumab), and more are in the pipeline. The drugs’ launches have been held up due to patent litigation, but the first product is expected to come onto the U.S. market in January 2023, with others launching in the months following. Payers with more than one-third of both commercial and Medicare lives said that when those drugs come onto the market, they expect to establish a market basket based on mechanism of action, such as phosphodiesterase-4 (PDE4), Janus kinase (JAK) and tumor necrosis factor (TNF) inhibitors.
Of the therapies prescribed for psoriasis, there is no clear preferential treatment among dermatologists, with about one-quarter of their unique patients being treated with Amgen Inc.’s Otezla (apremilast), Eli Lilly and Co.’s Taltz (ixekizumab) and Humira. Less prescribed were biosimilars. Humira had the largest number of high-prescribing dermatologists — those who prescribe a product to 50% or more patients — followed by Taltz and Stelara (ustekinumab) from the Janssen Pharmaceutical Companies of Johnson & Johnson.
Message: “This medication can lead to clearer skin with just six doses per year. Trial results have shown improvement in 90% of patients at four months. Many patients began to see improvement quickly. This medication is an injection, and patients and families can receive support through the nurse ambassador via the manufacturer. This medication is a biological; it interferes with certain proteins. It does have serious side effects, as it weakens the immune system.”
Payer Thoughts: “This medication has a clear advantage with such little injections per calendar year.”
Payers, Dermatologists Say They Are Interested in New Psoriasis Topicals Vtama, Zoryve
Two new drugs to treat plaque psoriasis are adding to the topical options available to treat the condition. Both payers and dermatologists have expressed interest in the agents, according to Zitter Insights, and the class remains a high priority for payer management.
FDA Approves Rinvoq for Psoriasis
On Dec. 14, 2021, the FDA approved another indication for AbbVie Inc.’s Rinvoq (upadacitinib) for the treatment of adults with active psoriatic arthritis who have had an inadequate response or intolerance to at least one tumor necrosis factor (TNF) inhibitor. The agency initially approved the Janus kinase (JAK) inhibitor on Aug. 16, 2019.