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.
Among the therapies prescribed for psoriasis, Novartis Pharmaceuticals Corp.’s Cosentyx (secukinumab), Amgen Inc.’s Otezla (apremilast) and AbbVie Inc.’s Humira (adalimumab) were most frequently prescribed. The treatments prescribed least often were Remicade (infliximab) from Janssen Biotech Inc., a Johnson & Johnson company, and two of its biosimilars, Inflectra (infliximab-dyyb) from Pfizer and Celltrion Inc. and Renflexis (infliximab-abda) from Merck & Co. and Samsung Bioepis Co. Ltd.
Almost one-fourth of dermatologists consider AbbVie’s Skyrizi (risankizumabrzaa) the most ideal first-line treatment, citing its effectiveness and good side effect profile, followed closely by Cosentyx (see chart). Humira was the top second-line treatment, with Eli Lilly and Co.’s Taltz (ixekizumab) also getting high marks.
Mechanism of Action
Tumor necrosis factor (TNF) inhibitors have been on the market to treat psoriasis for a long time. Other relatively newer options include various interleukin (IL) inhibitors and phosphodiesterase type 4 (PDE4) inhibitors. Almost two-thirds of dermatologists prefer to prescribe IL-23 agents as first-line treatment over TNF inhibitors, and more than half say they prescribe IL-17 therapies over the TNF inhibitors in the first-line setting. More than half say it is unlikely that they will not prescribe a TNF inhibitor to treatment-naïve people with psoriasis.
Two biosimilars of Remicade were on the U.S. market at the time of the survey: Inflectra and Renflexis. Commercial payers with more than half of covered lives continue to cover Remicade; however, those covering almost one-third of lives are not covering it anymore. Some dermatologists say they are likely to prescribe the biosimilars only if payers mandate that they do so.
In January 2020, AbbVie unveiled Phase III clinical trial results showing that Skyrizi, an IL-23, demonstrated superiority to Cosentyx, an IL-17, in adults with moderate to severe plaque psoriasis. Payers with almost half of lives are likely to prefer Skyrizi over Cosentyx, while those covering more than half of lives are unlikely to prefer Skyrizi over all other IL-17s. However, almost two-thirds of dermatologists are likely to prescribe Skyrizi over the IL-17s, and three-quarters likely will prescribe it over the other IL-23 inhibitors (see chart).
Message: “The health economic review of Taltz also looked at number needed to treat and cost per additional number needed to treat. Taltz was determined to be the most effective treatment when compared to all other biologic approved to treat Psoriasis to achieve PASI 100. The reviewers also looked at PASI 75 and PASI across products for number needed to treat and cost effectiveness.”
Payer Thoughts: “Interesting review of Taltz that shows it outperforms other products to achieve PASI 100 and it’s more cost effective than other products on the market before 2017.”
Express Scripts Nixes Cosentyx in 2021
Cigna Corp.-owned PBM Express Scripts says it will exclude nearly 150 brand medications in its 2021 National Preferred Formulary. One consultant says the exclusion of Novartis Pharmaceuticals Corp.’s biologic Cosentyx (secukinumab), approved for plaque psoriasis, psoriatic arthritis, non-radiographic axial spondyloarthritis and ankylosing spondylitis, is likely to cause member disruption.
Study Shows Growing IL-17 Use in Psoriasis
For many years, the psoriasis treatment landscape was dominated by tumor necrosis factor (TNF) inhibitors. But with the FDA’s approval of three interleukin-17 (IL-17) inhibitors — as well as other drugs with different mechanisms of action — for the condition, those therapies are becoming more common among treatment regimens.