The dynamic multiple sclerosis (MS) market in the United States features more than a dozen high-cost branded (and one generic) disease-modifying therapies (DMTs) and an active pipeline. As the market continues to evolve, a shift towards greater emphasis on value assessment is coming; recent entrant Ocrevus offers a strong clinical profile at a compelling price and as generic versions of entrenched DMTs for relapsing forms of MS (Teva’s Copaxone 40 mg 3TW, oral agents) will launch over the next few years. As these forces give payers new leverage to control surging drug costs in MS, understanding the influence of clinical metrics and value-for-dollar on market access and medical practice—as well as the intersection of these forces and stakeholders—is key for developers of novel or next-generation DMTs. Multiple Sclerosis | Access & Reimbursement | US provides in-depth insight regarding the current and future impact of payer policy on physician prescribing behavior and DMT usage patterns.
Questions Answered in this Report:
- With high list prices and expanding treatment choice, MS DMTs are frequently subject to reimbursement restrictions and utilization controls. Which MS DMTs receive favorable formulary placement, and what approaches do payers employ to manage utilization and costs? How restrictive do prescribers perceive these controls to be? How do utilization controls impact prescribing and DMT selection?
- As DMT costs rise, payers will increasingly focus on value assessment and pharmacoeconomic analysis in formulary decision-making. How are MCOs performing value assessments for MS DMTs, and what are the preferred pharmacoeconomic models? How do MCOs plan to respond to ICER’s report on comparative cost-effectiveness of MS DMTs?
- The recent and anticipated launches of generic versions of entrenched DMTs in the United States in the coming years could alter DMT reimbursement. What has been the impact of Momenta/Sandoz’s Glatopa on MS reimbursement dynamics, and how will the emergence of future generic versions of glatiramer acetate impact formulary and prescribing decisions? How will generic oral DMTs fit into neurologists’ prescribing patterns and how do MCOs plan to manage utilization of these agents compared with their branded counterparts?
- Emerging MS DMTs that are able to meaningfully differentiate from current DMTs on clinical or cost factors will be most likely to obtain favorable market access/reimbursement terms from MCOs. How will new brands be reimbursed and prescribed in an increasingly crowded market? What improvements do neurologists and MCOs desire from emerging therapies?
Markets covered: United States.
Methodology: Surveys of 100 neurologists and 30 managed care company officials, including 15 pharmacy directors and 15 medical directors, in February 2017.
Indication coverage: Multiple sclerosis.
Key drugs covered: Aubagio, Avonex, Betaseron, Copaxone, Extavia, Gilenya, Glatopa, Lemtrada, Plegridy, Tecfidera, Tysabri, Zinbryta, Ocrevus, ozanimod, siponimod
Key companies mentioned: AbbVie, Bayer HealthCare, Biogen, Celgene, EMD Serono, Novartis, Pfizer, Roche/Genentech, Sanofi/Genzyme, Teva