Systemic Lupus Erythematosus – Access & Reimbursement – Access & Reimbursement – Systemic Lupus Erythematosus (US)

The systemic lupus erythematosus (SLE) therapy market in the United States is largely genericized and off-label. With the exception of GlaxoSmithKline’s Benlysta, AstraZeneca’s Saphnelo and Aurinia’s Lupkynis are the first for this indication in almost 60 years. Because all approved targeted therapies of SLE are expensive, access to it is typically restricted by payers. Several therapies are in late-phase development for SLE. This report examines the prescribing and reimbursement environment for key current therapies and emerging SLE agents in the United States, according to surveyed rheumatologists and MCO PDs / MDs. The content explores how physicians and payers perceive current and emerging SLE therapies and the reimbursement dynamics that will promote or restrict market access to the agents.

Questions answered

• What is the extent of MCO coverage of Benlysta, Saphnelo, Lupkynis, and off-label Rituxan, and how do the coverage policies affect rheumatologists’ prescribing of these drugs? Where do the rituximab biosimilars fit in the SLE treatment algorithm?
• Will the approval of Gazyva and Cosentyx for LN affect their coverage on commercial plans? How do rheumatologists perceive these agents for LN, and where in the treatment algorithm do physicians anticipate using them?
• How do physicians anticipate using dapirolizumab pegol, litifilimab, upadacitinib, and deucravacitinib which are in development for moderate to severe nonrenal SLE, and how do payers expect to cover these therapies on commercial plans?

Content highlights

Geography: United States.

Primary research: Survey of 100 U.S. rheumatologists and 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).

Key drugs covered: Benlysta, Saphnelo, Lupkynis, Rituxan, rituximab biosimilars, tacrolimus, mycophenolate mofetil, dapirolizumab pegol, litifilimab, upadacitinib Cosentyx, Gazyva.

Reimbursement and contracting.

Access and prescribing.

Special topics.

Opportunities and challenges for emerging therapies.

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.