Rheumatoid Arthritis | Access and Reimbursement | Brazil | 2016

Introduction

Rheumatoid arthritis (RA) is a chronic disease that affects more than 1 million Brazilians and often requires the use of premium-priced therapies. The coverage of these drugs is extensive, and rheumatologists have several therapeutic options available for the treatment of RA patients. However, the long period on the market and the extensive experience rheumatologists have with biologic agents, particularly TNF-α-inhibitors, represents a challenge to the use of new molecules, forcing them to compete for use in TNF-α-inhibitor-refractory patients. More recently, two biosimilars became available, and it is anticipated that more biosimilars will be launched in the short to mid term, representing an additional challenge to current therapies. In addition, Brazil is a sizeable and heterogeneous country that is currently experiencing an economic crisis that may exacerbate current access barriers. New agents to market will encounter an increasingly competitive market and a country that will be trying to meet clinical needs while keeping the budget balanced. This Access & Reimbursement analysis provides important insights for navigating the RA market in Brazil and adjusting to payers’ and physicians’ needs and expectations.

Scope:

For this Access & Reimbursement module on RA, we surveyed 52 rheumatologists and 3 payers to explore the current and future dynamics in the use and coverage of premium-priced RA therapies in Brazil.

Markets covered: Brazil.

Primary research:

• 52 rheumatologists.
• 3 payers/payer-advising thought leaders who have influence on patient access to premium-priced RA therapies at a regional or national level were interviewed:
  • Member of the National Committee for Incorporation of Technologies in the Health System (CONITEC); current ad-hoc consultant for Ministry of Health and specialist in pharmacoeconomics.
  • Rheumatologist KOL; member of the Rheumatology Departments of São Paulo’s State Health Department and one of the most important private hospitals in Brazil; active member of the drug standardization (P&T) committee of these institutions.
  • Medical audit department manager of important Brazilian HMO with nationwide operations.

Questions Answered in This Report:

· Market access landscape for current RA therapies in Brazil. Which biologic and synthetic agents are available for the treatment of RA in Brazil? Which of them are covered in the public and private sectors? Which barriers to diagnosis and treatment do RA patients encounter, and how do they vary across the country? What are the current drivers of physician prescribing of RA therapies?

· Current and future impact of payer policies on prescribing trends for RA.What does an analysis of prescribing patterns for currently available RA therapies reveal about the real-life impact of payer policies in Brazil? How do reimbursement/coverage constraints limit prescribing and rank against other market access hurdles? How do health authorities’ policies impact the prescription of biosimilars?

· Perception, challenge, and differentiating factors for emerging RA therapies. How will payers and prescribers perceive the emerging therapies? What challenges will those therapies need to overcome? How do new therapies meet physicians’ needs, and how do physicians expect to prescribe them? What differentiating characteristics will new therapies need for success with coverage requests? What will be the importance of head-to-head and pharmacoeconomic outcomes against current therapies for coverage decisions?