Schizophrenia | Access & Reimbursement | US | 2023
Atypical antipsychotics—the cornerstone of schizophrenia treatment—are available as oral and injectable (e.g., long-acting injectable [LAI]) formulations in the United States. Many of the oral atypical antipsychotics are generically available, thereby creating barriers to access for branded oral agents, which many payers list as nonpreferred or not covered at all, and psychiatrists relegate them to later lines of therapy (e.g., Alkermes’s Lybalvi, Intra-Cellular Therapies’ Caplyta). Newer LAI formulations of atypical antipsychotics (e.g., Teva’s Uzedy, Janssen’s Invega Hafyera) offer the possibility of better patient compliance, although access to these therapies may be restricted because of their high cost. Given the wide variety of antipsychotic therapy options available, novel emerging therapies will be entering a crowded and highly genericized market. Nevertheless, targeting areas of high unmet need (e.g., cognitive impairment in schizophrenia, negative symptoms of schizophrenia) may facilitate a favorable market access environment.
Questions answered
- What do payers report as the coverage status of branded orals and LAIs on commercial plans? What are the common utilization management strategies that payers use?
- How do payer policies affect the prescribing of branded oral atypical antipsychotics (e.g., Lybalvi, Caplyta) and LAIs (e.g., Otsuka / Lundbeck’s Abilify Maintena, Janssen’s Invega Hafyera) in this genericized market?
- What strategies will surveyed payers use as more LAIs (e.g., Lundbeck / Otsuka’s Abilify Asimtufii, Teva’s Uzedy) enter the schizophrenia market? What will be the anticipated impact of the future availability of generic Abilify Maintena on LAI coverage and prescribing?
- How do payers anticipate covering select emerging schizophrenia therapies (i.e., Boehringer Ingelheim’s iclepertin, Acadia Pharmaceuticals’ pimavanserin, Karuna Therapeutics’ KarXT) in their largest commercial plans, and how does this coverage align with psychiatrists’ anticipated prescribing of these agents?
Geography: United States
Primary research: Survey of 102 U.S. psychiatrists, survey of 30 U.S. MCO PDs/MDs
Fingertip formulary: Formulary coverage and restrictions data for schizophrenia therapies by commercial plans covering 169.5 million lives nationally and managed Medicaid plans covering 88.1 million Medicaid lives
Key drugs covered: Caplyta, Lybalvi, Vraylar, Rexulti, Igalmi, Aristada, Invega Hafyera, Invega Sustenna, Abilify Maintena, Abilify Asimtufii, Rykindo, Uzedy, KarXT, iclepertin, pimavanserin
Content highlights
Reimbursement and contracting
Access and prescribing
Opportunities and challenges for emerging therapies
Disease-specific special topic: CIAS and negative symptoms of schizophrenia
Product description
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment. Each report includes up-to-date analyses of drug coverage and restriction policies as well as payer and prescriber perspectives on key marketed drugs and their receptivity to emerging therapies.
