Market Access

MMIT Reality Check on Atopic Dermatitis (May 2021)

May 14, 2021

According to our recent payer coverage analysis for atopic dermatitis treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

According to our recent payer coverage analysis for atopic dermatitis treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for atopic dermatitis treatments shows that under the pharmacy benefit, about 23% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: Sanofi and Regeneron’s Dupixent (dupilumab) and Pfizer Inc.’s Eucrisa (crisaborole) are competing for preferred status after topical corticosteroids and topical calcineurin inhibitors and phototherapy. Numerous companies are poised to enter the same market space, many with new biological agents.

by Matt Breese

MMIT Reality Check on Narcolepsy (May 2021)

May 7, 2021

According to our recent payer coverage analysis for narcolepsy treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

According to our recent payer coverage analysis for narcolepsy treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for narcolepsy treatments shows that under the pharmacy benefit, about 54% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: In October 2020, the FDA gave another approval to Harmony Biosciences Holdings, Inc.’s Wakix (pitolisant) for the treatment of cataplexy in adults with narcolepsy. The agency initially approved the selective histamine 3 (H3) receptor antagonist/inverse agonist on Aug. 15, 2019.

by Matt Breese

MMIT Reality Check on Anemia — Chronic Kidney Disease (Apr 2021)

April 30, 2021

According to our recent payer coverage analysis for anemia treatments due to chronic kidney disease, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

According to our recent payer coverage analysis for anemia treatments due to chronic kidney disease, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for anemia treatments due to chronic kidney disease shows that under the pharmacy benefit, about 39% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: New-to-market products will have to compete with well-established erythropoiesis-stimulating agents and a biosimilar, as well as an IV iron replacement product for people not on dialysis. Products with improved side-effect profiles compared with ESAs will have an advantage.

by Matt Breese

Radar On Market Access: So Far, New Therapies Have Limited Impact on ADHD Management

April 27, 2021

In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them, AIS Health reported.

On April 2, the FDA approved Supernus Pharmaceuticals, Inc.’s Qelbree (viloxazine extended-release capsules) for treating ADHD in patients ages 6 to 17 — a therapy that “represents the first novel non-stimulant treatment for ADHD in a decade,” according to the manufacturer.

In recent months, some innovative treatments have emerged for attention deficit hyperactivity disorder (ADHD), which affects millions of children and is one of the most common neurodevelopmental disorders in childhood. But because those therapies are so new — and in one case, very unconventional — payers appear reticent to change their coverage tactics to accommodate them, AIS Health reported.

On April 2, the FDA approved Supernus Pharmaceuticals, Inc.’s Qelbree (viloxazine extended-release capsules) for treating ADHD in patients ages 6 to 17 — a therapy that “represents the first novel non-stimulant treatment for ADHD in a decade,” according to the manufacturer.

“Qelbree may bring competition to the non-stimulant ADHD market if it continues to show promising data of earlier onset of action compared to Strattera,” says Mesfin Tegenu, R.Ph., CEO of RxParadigm. Both Qelbree and Eli Lilly and Co.’s Strattera (atomoxetine), which are non-stimulants, have the advantage of avoiding the abuse and addiction risks posed by other ADHD therapies like Ritalin (methylphenidate) and Adderall (amphetamine/dextroamphetamine).

“Based on current Phase III studies, Qelbree began to show improvement after the first week of therapy through the end of the study at week 7, while Strattera requires 4 to 8 weeks to begin working,” Tegenu points out. Ultimately, he adds, “more information will be needed before we see a shift in payers’ attitude towards Qelbree.”

Qelbree is not the only new ADHD treatment to make headlines in the last year. In June 2020, the FDA approved the “first game-based digital therapeutic device to improve attention function in children with ADHD.” The EndeavorRx device, manufactured by the Canadian company Ehave, Inc., is available only by prescription and is designed for patients between 8 and 12 years old who are primarily inattentive or combined-type ADHD with a demonstrated attention issue. The device currently is not covered by health insurance, according to the EndeavorRx website, although the manufacturer said it is trying to change that.

Even with these new treatments coming to market, Tegenu points out that behavioral therapy is generally recommended as the first-line treatment for preschool-age children who have been diagnosed with ADHD. That may be “followed by the addition of methylphenidate based on tolerability profile, if warranted,” he says.

Similar to their younger counterparts, children and adolescents who are in elementary school and older “may receive behavioral therapy and stimulant medication to help achieve target goals and improve symptoms,” Tegenu adds.

by Leslie Small

 

MMIT Reality Check on Hemophilia B (Factor IX) (Apr 2021)

April 23, 2021

According to our recent payer coverage analysis for hemophilia B (factor IX) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

According to our recent payer coverage analysis for hemophilia B (factor IX) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for hemophilia B (factor IX) treatments shows that under the pharmacy benefit, about 37% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: Anticipated product approvals may develop improved product placement based on potential cost, adherence and efficacy advantages. The hemophilia market will be managed more tightly as we start seeing an increase in long-acting products.

MMIT Reality Check on Growth Hormone Deficiency (Apr 2021)

April 16, 2021

According to our recent payer coverage analysis for growth hormone deficiency (GHD) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

According to our recent payer coverage analysis for growth hormone deficiency (GHD) treatments, combined with news from key healthcare influencers, market access is shifting in this drug landscape.

To help make sense of this new research, MMIT’s team of experts analyzes the data and summarizes the key findings for you. The following are brief highlights. To read the full piece, including payer coverage, drug competition and prescriber trends, click here.

Payer Coverage: A review of market access for growth hormone deficiency treatments shows that under the pharmacy benefit, about 55% of the lives under commercial formularies are covered with utilization management restrictions.

Trends: When the FDA approved Novo Nordisk, Inc.’s Sogroya (somapacitanbeco) for the replacement of growth hormone in adults with growth hormone deficiency in August 2020, it became the only long-acting agent on the market. A survey by Zitter Insights shows that many endocrinologists expect to shift prescribing to such agents from the short-acting growth hormones.