Acute Pain | Access and Reimbursement | Postoperative Pain | US | 2017

The landscape of prescription drugs to manage pain in the postoperative setting represents a sizable but fragmented and challenging environment for drug marketers given the abundance of generically available analgesics. As the treatment landscape for postoperative pain becomes increasingly complex, we explore the market access opportunities and challenges for drug marketers, particularly in an era of ever-tightening reimbursement in the United States. Research and analysis in this report will assess physician prescribing practices of current analgesics for postoperative pain treatment, including drugs delivered by patient-controlled administration (i.e., The Medicines Company’s Ionsys), the impact of hospital protocols and other restrictions on prescribing, and the expected uptake and formulary coverage of emerging pain therapies.

Questions answered:

• With many generics available, hospital pharmacies use a variety of measures to control utilization of branded therapies. Which postoperative pain agents and classes commonly receive favorable hospital formulary placement, and what approaches are employed to manage utilization and costs? Which restrictions are most common for selected branded agents?
• The costs of many surgical procedures and associated aftercare are often reimbursed via bundled payments from payers.  What is the impact of payment bundling for surgical procedures on prescribing and reimbursement practices related to postoperative pain management?
• Throughout the pharmaceutical industry, pharmacoeconomic assessments are becoming more commonplace. How are hospital PDs performing value assessment for postoperative pain agents, and what are the preferred pharmacoeconomic models? Is cost-effectiveness data required for P&T committee formulary coverage reviews?
• A number of ETs are in development for the treatment of moderate to severe postoperative pain. How do hospital PDs anticipate including emerging pain therapies on formularies at various price points, and how do physicians anticipate incorporating them in the treatment of postoperative pain?
• Scope:
  • Markets covered: United States.
  • Methodology: Survey of 52 surgical specialists, 54 anesthesiologists, and 30 hospital PDs in the United States, completed in April 2017.
  • Indication coverage: Moderate to severe postoperative pain.
  • Key drugs covered: Caldolor, Dyloject, Exparel, Ionsys, Ofirmev, Opana (parenteral), Sprix.
  • Key companies mentioned: Cumberland Pharmaceuticals, Pfizer, Pacira Pharmaceuticals, The Medicines Company, Mallinckrodt Pharmaceuticals, Endo Pharmaceuticals, Egalet.