Ulcerative Colitis – Access & Reimbursement – Access & Reimbursement – Ulcerative Colitis (US)

TNF-alpha inhibitors (e.g., Johnson & Johnson Innovative Medicine’s Remicade, AbbVie’s Humira) are entrenched in the U.S. ulcerative colitis (UC) therapy market. Alternative treatment options include Takeda’s Entyvio, Pfizer’s Xeljanz, Johnson & Johnson Innovative Medicine’s Stelara, BMS’s Zeposia, and AbbVie’s Rinvoq), as well as the recently launched agents Velsipity (Pfizer), Omvoh (Eli Lilly), Skyrizi ( AbbVie), and Tremfya (Johnson & Johnson Innovative Medicine). Also competing in this market is biosimilar infliximab (e.g., Pfizer’s Inflectra, Merck’s Renflexis). The launch of adalimumab biosimilars (e.g., Amjevita) and the potential arrival of emerging agents—some with novel MOAs (including Abivax’s ABX464, Merck’s MK-7240)—will further fuel competition and add to pricing pressure. This report addresses the market access challenges facing emerging therapies, with insights into securing favorable coverage and uptake.

QUESTIONS ANSWERED

• How do MCO restrictions impact physicians’ prescribing of biologics / oral targeted agents for UC?
• How do MCOs cover branded biologics / oral targeted agents in their largest fully insured commercial plans, and which utilization management controls do they use
• How do pharmacoeconomic / health economic and outcomes research data impact formulary decision-making about therapies for UC?
• How do payers expect to cover emerging/recently approved therapies, including Skyrizi, Tremfya, ABX464, and MK-7240, in their commercial health plans, and how does this coverage align with physicians’ anticipated prescribing of these agents?

PRODUCT DESCRIPTION

Leveraging Clarivate’s proprietary data sources and surveys with physicians and payers, Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of payer policy on physician prescribing behavior in the United States. Through detailed analyses of drug coverage, restriction policies, and contracting, as well as payer and prescriber perspectives on key marketed drugs and their receptivity to emerging therapies, this report enables you to:

• Identify and learn how to overcome roadblocks to market access to best position your brand.
• Identify key stakeholders and reimbursement drivers and assess the impact that reimbursement decisions have on treatment selection.
• Evaluate competitor strategies for securing favorable market access terms.

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

Fingertip Formulary: Formulary coverage by commercial plans covering more than 165 million lives nationally and Medicare Part D plans covering up to 37.5 million lives.

Real-world data: U.S. pharmacy and medical claims data

Key drugs: Remicade, Humira, biosimilar adalimumab, biosimilar infliximab, Entyvio, Stelara, Xeljanz, Rinvoq, Zeposia, Skyrizi, Tremfya, Omvoh, Velsipity.