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 than four-fifths of covered commercial lives and those with almost two-thirds of Medicare lives said that managing brand drugs for psoriasis is a high or very high priority. Respondents covering more than half of lives said that those drugs have a high or very high impact on their budget. Payers representing almost one-quarter of commercial lives categorized their management of those agents as aggressive, while those with more than a third of Medicare lives said they very aggressively manage the brand drugs.
More than half of dermatologists and payers with more than half of lives said they are highly satisfied with the available drugs for treating psoriasis. More than half of dermatologists said there is a high or very high disease burden for people with the condition.
Social Determinants of Health
Among payers covering commercial lives, the top social determinants of health initiative for disadvantaged members with psoriasis was offering greater access to telehealth — which is done by payers with more than two-thirds of lives — followed by providing services to support health/medicine literacy, as well as services to assist in health/medicine language barriers and educational content about healthy living. For Medicare payers, the top programs were supplying greater access to telehealth, followed closely by providing services to support health/medicine literacy and services to help overcome health/medicine language barriers. Dermatologists ranked a person’s socioeconomic status as the top social determinant of health factor impacting patients’ ability to access health care services and therapy, followed by education and health literacy.
On Sept. 9, 2022, the FDA approved Bristol Myers Squibb’s Sotyktu (deucravacitinib) for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. The agent is a first-in-class, oral, selective, allosteric tyrosine kinase 2 (TYK2) inhibitor. Half of dermatologists said they expect it will have some impact on their treatment approach with certain patients. Payers covering more than one-third of commercial lives said they expect the drug to have some impact on their management of other psoriasis agents, while those with almost half of Medicare beneficiaries expect it to have no impact.
At least two biosimilars of Stelara (ustekinumab) from Janssen Biotech, Inc., a Johnson & Johnson company, are in the late-stage pipeline: Amgen Inc.’s ABP 654 and Alvotech and Teva Pharmaceuticals, Inc.’s AVT04. Stelara, a human interleukin-12/-23 antagonist, is indicated for adults with moderate-to-severe plaque psoriasis, as well as other inflammatory conditions. Its patent protections will start to expire in September 2023, and Johnson & Johnson has settled patent lawsuits with the companies allowing Amgen to launch no later than Jan. 1, 2025, and Alvotech and Teva to launch their biosimilar no later than Feb. 21, 2025. About half of dermatologists said they expect the new agents to have some impact on their treatment approach for psoriasis. Payers with almost 90% of Medicare lives said they expect both drugs will have some impact on their management of other psoriasis agents, while those covering almost half of commercial lives expect the products to have a moderate or high impact.
Message: “Amgen has a strong presence in rheumatology and GI offices, which positions it well to converting share of biosimilar. With Amjevita and an upcoming Stelara biosimilar, Amgen will represent 70% of the current inflammation market. They also have the most experience converting patients to adalimumab biosimilars worldwide.”
Payer Thoughts: “These are all ‘nice to have’ bonuses of going with Amgen’s product, but I don’t think anything will sway over a significantly cheaper biosimilar product.”
Several Biosimilars of Humira Launched This Month With Varying WACs
As expected, early July 2023 saw the launch of multiple biosimilars of AbbVie Inc.’s Humira (adalimumab). Most of them launched with wholesale acquisition costs (WACs) just slightly less than that of the reference drug, but a few undercut that price fairly significantly.
Amjevita, First Biosimilar of Humira, Launches With Two-Tiered Pricing Strategy
More than six years after the FDA approved it, the first biosimilar of AbbVie Inc.’s Humira (adalimumab) has finally launched in the U.S. On Jan. 31, Amgen Inc.’s Amjevita (adalimumab-atto) became available at two different wholesale acquisition costs — one 55% below Humira’s WAC and one 5% below it — a strategy that acknowledges the lure of rebates within the U.S. market. It remains to be seen whether additional adalimumab biosimilars launching this year will follow suit or explore a different strategy to differentiate themselves.