Crohn’s Disease – Access & Reimbursement – Access & Reimbursement – Crohn’s Disease (US)

TNF-α inhibitors, such as J&J Innovative Medicine’s Remicade and AbbVie’s Humira, remain firmly established in the U.S. Crohn’s disease (CD) treatment landscape. However, therapies with alternative mechanisms of action—including Takeda’s Entyvio, J&J Innovative Medicine’s Stelara, and AbbVie’s Skyrizi and Rinvoq—along with recently launched agents such as Eli Lilly’s Omvoh and J&J Innovative Medicine’s Tremfya, are gaining traction and reshaping treatment paradigms. In parallel, growing uptake of infliximab and adalimumab biosimilars will broaden therapeutic options. Furthermore, the introduction of ustekinumab biosimilars, including Wezlana and Selarsdi, together with the anticipated entry of emerging agents—some featuring novel mechanisms of action, such as Merck’s tulisokibart, Roche’s afimkibart, Sanofi/Teva’s duvakitug, and J&J Innovative Medicine’s icotrokinra—is expected to intensify competition and exert additional pricing pressure. This report examines market access challenges facing emerging therapies, offering insights into strategies for achieving favorable coverage and driving uptake.

QUESTIONS ANSWERED

• How do MCO restrictions impact physicians’ prescribing of biologics / oral targeted agents for CD?
• 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 CD?
• How do payers expect to cover recently approved / emerging therapies, including Omvoh, Tremfya, tulisokibart, afimkibart, duvakitug, and icotrokinra, 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.

Geography: United States

Primary research: Survey of 100 U.S. gastroenterologists and 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs). Interviews with 2 U.S. MCO PDs/MDs.

Fingertip Formulary: Formulary coverage by commercial plans covering more than 163 million lives nationally.

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

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