MMIT Reality Check on Schizophrenia (Sept 2021)

Payer Coverage:

A review of market access for schizophrenia treatments shows that under the pharmacy benefit, about 26% of the lives under commercial formularies are covered with utilization management restrictions. About 13% of the lives under Medicare Part D formularies are not covered for at least one of the drugs.

Under the medical benefit, 10% of the lives under commercial policies are covered with utilization management restrictions. Meanwhile, almost 89% of the lives under Medicare Part B policies have access to at least one of the drugs without utilization management restrictions.

For about 71% of the covered lives, payer pharmacy benefit formularies do not require step therapy (ST). Of the lives that require ST, 33% require multiple steps. Around 22% of payer-controlled pharmacy benefit covered lives require prior authorization, with 58% of those lives covered by policies that are restrictive as compared with a product’s FDA-approved label.

Trends:

FDA Approves Invega Hafyera

In September 2021, the FDA approved long-acting atypical antipsychotic Invega Hafyera (6-month paliperidone palmitate) from Janssen Pharmaceuticals, Inc., a Johnson & Johnson unit, for the treatment of schizophrenia in adults. The drug is the first-and-only twice-yearly injectable approved to treat the disease, according to the company.

FDA’s Approval Expands J&J’s Market Share

The FDA in September 2021 approved Johnson & Johnson’s Invega Hafyera for the treatment of schizophrenia, expanding the drugmaker’s hold on the market. First approved in 2006, J&J’s extended release Invega tablet holds covered or better status for 75% of all insured lives under the pharmacy benefit, as of September 2021. Two other long-acting injectable forms of the drug, Invega Sustenna (77% covered or better) and Invega Trinza (58% covered or better) are also on the market.

FDA Approves Caplyta

In December 2019, the FDA approved Intra-Cellular Therapies, Inc.’s Caplyta (lumateperone) for the treatment of schizophrenia in adults. The drug is an oral, once-daily medicine and is being developed for the treatment of bipolar depression; behavioral disturbances in patients with dementia, including Alzheimer’s disease; depression; and other neuropsychiatric and neurological disorders, according to the company.

Key Findings:

Market Events Drive Changes

In September 2021, the FDA approved long-acting atypical antipsychotic Invega Hafyera (6-month paliperidone palmitate) from Janssen Pharmaceuticals, Inc., a Johnson & Johnson unit, for the treatment of schizophrenia in adults. In December 2019, the FDA approved Intra-Cellular Therapies, Inc.’s once-daily Caplyta (lumateperone) for the treatment of schizophrenia in adults. In October 2019, the agency approved Hisamitsu Pharmaceutical Co., Inc. subsidiary Noven Pharmaceuticals, Inc.’s Secuado (asenapine) transdermal system, the first-and-only transdermal patch formulation for the treatment of adults with schizophrenia.

Competitive Market Landscape

There is a shift towards more integration of Medicaid benefits into managed care contracts, as well as a slight decline in the use of carve-out financing. Competitive contracting on brand name oral atypical antipsychotics is expected.

Pharmacy Benefit Implications

Coverage is primarily under the pharmacy benefit, but medical benefit coverage is available for some medications. Coverage is restricted for most brand name oral atypical antipsychotics, which will require a step through generic products. Medicaid is the largest payer for mental health services. There has been a shift in the Medicaid behavioral health carve-out landscape.

Key Players in Market:

0 Comments

AIS Health Staff

Related Posts

https://www.mmitnetwork.com/wp-content/uploads/2021/10/WordPress-Featured-Image_Diabetes.jpg
November 24

MMIT Reality Check on Type 2 Diabetes (DPP4 and Combo)

Read More
https://www.mmitnetwork.com/wp-content/uploads/2021/11/wordpress-featured-image-reality-check-colorectal-cancer.jpg
November 19

MMIT Reality Check on Colorectal Cancer

Read More
https://www.mmitnetwork.com/wp-content/uploads/2021/11/wordpress-featured-image-reality-check-cystic-fibrosis.jpg
November 12

MMIT Reality Check on Cystic Fibrosis

Read More

GAIN THERAPEUTIC AREA-SPECIFIC INTEL TO DRIVE ACCESS FOR YOUR BRAND

Sign up for publications to get unmatched business intelligence delivered to your inbox.

subscribe today