Zitter Pulse Check: Ulcerative Colitis (November 2022)

Coverage

Ulcerative colitis 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 ulcerative colitis, 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: Ulcerative Colitis 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

Payers covering more than half of commercial lives said that managing branded treatments for ulcerative colitis was a high priority for them. Medicare payers with almost half of lives considered management of the condition a very high priority. Payers with around two-fifths of lives said they have an aggressive management approach.

Plans with around two-thirds of lives expressed average satisfaction with current ulcerative colitis treatments. Almost four-fifths of gastroenterologists rated their satisfaction as average or high. Commercial payers with almost three-fourths of lives said there is moderate unmet need in treating the condition. Payers covering almost half of commercial lives reported that the drugs to treat ulcerative colitis have a high impact on their budget.

Key Findings

Physician Prescribing

The No. 1 treatment for ulcerative colitis was AbbVie Inc.’s Humira (adalimumab), which gastroenterologists used to treat more than one-third of their unique patients. That was followed closely by Johnson & Johnson subsidiary Janssen Biotech, Inc.’s Remicade (infliximab) and Takeda Pharmaceutical Company Limited’s Entyvio (vedolizumab). Among the three available Remicade biosimilars, Pfizer Inc.’s Inflectra (infliximab-dyyb) — the first of those agents to launch, in late November 2016 — was prescribed most often, followed by Organon’s Renflexis (infliximab-abda), which entered the U.S. market in July 2017 and then Amgen Inc.’s Avsola (infliximab-axxq), which had the most recent launch in July 2020.

Rinvoq

On March 16, 2022, the FDA approved AbbVie Inc.’s Rinvoq (upadacitinib) for the treatment of adults with moderately to severely active ulcerative colitis who have had an inadequate response or intolerance to at least one tumor necrosis factor (TNF) blocker. At the time of the survey, payers with almost three-fourths of lives said that their company had conducted a P&T review of the Janus kinase (JAK) inhibitor. Among payers that had not had a P&T review, those covering nearly all lives said a moderate need in treating ulcerative colitis exists with the availability of Rinvoq. Payers covering about two-thirds of commercial lives said that there is a high disease burden for people living with the condition.

Social Determinants of Health

Among payers covering Medicare lives, the top social determinants of health initiatives for disadvantaged members with ulcerative colitis are greater access to telehealth — which is offered by payers with almost all lives — transportation to and from medical appointments and educational content about healthy living. Commercial payers said they also prioritize greater access to telehealth and educational content about healthy living, as well as services to assist in health/medicine language barriers. Gastroenterologists cited socioeconomic status, education and health literacy, and occupation and job security as the top non-medical factors impacting the ability of people with ulcerative colitis to access health care services and therapy.

Trends

Biosimilar Acceptance

Message: “Discussed timing of adalimumab biosims in 2023. Organon will have only high-concentration, citrate-free, interchangeable adalimumab biosim. Launch 7/1/2023. HCPs [i.e., health care providers] rank citrate-free #1 issue, #2 is [real-world evidence], #3 is manufacturer rep, #4 is interchangeability, #5 is device. Organon’s biosim will have simple two-step auto-injector (‘similar to EpiPen’). Will have robust patient support programs. Not sure yet on SP distribution model. Ustekinumab [i.e., Stelara] biosim expected September 2023.”

Payer Thoughts: “Good info and discussion. Decisions will be made 2023Q3. Will focus mostly on price — so different ranking of issues than those of HCPs. But if Organon has competitive price, all the other attributes above will make the decision easier. Once we go to a biosim, we have to move market share quickly. And once we have biosim Humira and Stelara, and future generic Xeljanz, we can hopefully get out from under the AbbVie and Janssen portfolio contracts and focus on net cost and value rather than rebates. Biggest category we have by far.”

FDA’s Rinvoq Approval Brings New Ulcerative Colitis Option

The FDA recently gave an additional indication to AbbVie Inc.’s Rinvoq (upadacitinib) in ulcerative colitis, broadening that therapeutic class even more. And while a study revealed some concerns around another agent with a similar mechanism of action, payers and gastroenterologists last year expressed interest in Rinvoq over other late-stage pipeline agents.

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

Researchers Examine CF, UC/Crohn’s Adherence, Say Specialty Pharmacies ‘Could Help Reduce Medical Burden’

Two recent studies of specialty-drug treated conditions examined the impact of adherence on hospitalizations and medical costs. Findings of the studies — one on cystic fibrosis (CF) and the other on ulcerative colitis (UC)/Crohn’s disease — from AllianceRx Walgreens Prime (which changed its name to AllianceRx Walgreens Pharmacy in late June) demonstrate the importance of specialty pharmacy interventions in helping keep patients adherent to therapy.

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

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