Rheumatoid Arthritis | Access and Reimbursement | US | 2017


The moderate to severe rheumatoid arthritis (RA) market is crowded; multiple targeted therapies are available, including nine different branded biologics, a biosimilar, and a small-molecule agent (Xeljanz), representing six distinct drug classes. With the recent entry of Inflectra, the expected launch of other biosimilars, and the introduction of emerging therapies (Jak and IL-6 inhibitors), marketers are facing increasing challenges to gain favorable formulary positioning and physician uptake. This content examines the prescribing and reimbursement environment for current and emerging RA agents, according to surveyed rheumatologists and managed care organization (MCO) pharmacy directors (PDs) and medical directors (MDs).

Questions Answered in This Report:

  • Prescribing and market uptake of RA biologics/Xeljanz. What is the patient share of individual RA biologics/Xeljanz in commercial and Medicare RA patients treated with these therapies? How will the availability of novel branded agents and biosimilars affect prescribing patterns by year-end 2020? What are the key drivers and obstacles for prescribers in the RA therapy market?
  • Reimbursement status and prescribing restrictions for RA biologics/Xeljanz. Which marketed RA biologics/Xeljanz have the most favorable coverage and tier placement on commercial and Medicare Advantage formularies and which are less favored by payers? What drivers are important to MCOPDs/MDs when making formulary and reimbursement decisions for RA drugs? What types of utilization management controls do payers place on RA biologics/Xeljanz and how do these restrictions affect physician prescribing of these therapies?
  • Uptake of biosimilars in the RA market. What is the current coverage and uptake of Inflectra in the RA market? What actions do payers anticipate taking regarding reimbursement of RA branded agents in response to Inflectra’s availability? How do payers and physicians view the emerging biosimilars? What portion of the total molecule patient share will be picked up by current and emerging biosimilars in new starts and from switching patients?
  • Outlook for emerging RA agents. If approved, how will the novel Jak inhibitor (baricitinib) and two novel IL-6 modulators (sarilumab and sirukumab) fit into physicians’ treatment algorithms for RA? How will price factor into these emerging agents’ tier placement on commercial plans? What types of pharmacoeconomic data could help manufacturers of emerging RA therapies secure more-favorable reimbursement terms?


  • Markets covered: United States.
  • Methodology: Surveys of 100 rheumatologists and 30 MCOs (14 PDs and 16 MDs) in February-March 2017.
  • Indication coverage: Rheumatoid arthritis.
  • Key drugs covered: Enbrel, Humira, Remicade, Simponi, Cimzia, Orencia, Actemra, Rituxan, Xeljanz, Inflectra, baricitinib, sarilumab, sirukumab, ABT-494, filgotinib, piclidenoson.
  • Key companies mentioned: AbbVie, Can-Fite, Eli Lilly, Galapagos, Gilead, GlaxoSmithKline, Incyte, Janssen, Regeneron, Sanofi.
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