Rheumatoid Arthritis | Access and Reimbursement | Argentina/Mexico | 2016

Introduction

Rheumatoid arthritis (RA) affects a significant percentage of Argentinian and Mexican populations and often requires the use of premium-priced biologics. Rheumatologists have several options available for the treatment of RA patients in these markets, yet drug coverage is fragmented across the different healthcare programs, and access to costly RA therapies is often limited in the public sector. New agents, along with a series of biosimilars, have recently entered or are about to enter the crowded RA space in these markets presenting an additional challenge to current RA therapies. However, the long postmarketing experience rheumatologists have with current biologic agents represents a barrier to the use of new molecules, particularly in earlier lines of therapy, forcing them to compete among TNF-α-inhibitor-refractory patients. New agents will meet an increasingly competitive market and two countries trying to meet clinical needs while keeping the budget balanced. This Access & Reimbursement analysis provides key insights for navigating the RA market in Argentina and Mexico while adjusting your brand’s value message to payers’ and physicians’ needs and expectations in each country.

Scope:

For this Access & Reimbursement module on RA, we surveyed 103 rheumatologists and 6 payers to explore the current and future dynamics in the use and coverage of premium-priced RA therapies in Argentina and Mexico. Interviewees have regional or national influence or inform regulations on RA.

Markets covered: Argentina and Mexico.

Primary research:

• 103 rheumatologists.
• 6 payers/payer-advising thought leaders who have influence on patient access to premium-priced RA therapies at the institutional, regional, or national level were interviewed:

• Argentina:
  • Rheumatologist KOL at a large academic, reference hospital in Buenos Aires; PAMI provider. Member of PANLAR. Chief of practical work of the rheumatology medical specialists career path at the UBA.
  • Superintendent of health services responsible for drafting regulatory framework for reimbursement with high-cost medicines at Obras Sociales. Consultant for UCEETS (Unidad Coordinadora de Evaluación de Tecnologías Salud) Regulatory.
  • Medical Audit Department Manager of important Argentinian HMO with nationwide operations.

• Mexico:
  • Coordinator of the National Guías de Práctica Clínica from CENETEC-Salud; internist at an IMSS hospital.
  • Head of the Pharmacy and Therapeutics Committee at ISSSTE.
  • President of the Colegio Mexicano de Reumatología; rheumatologist at a private hospital.

Questions Answered in This Report:

Market access landscape for current RA therapies in Mexico and Argentina. Which biologic and synthetic agents are available for the treatment of RA in Mexico and Argentina? Which of them are covered at a national and institutional level? Which barriers to diagnosis and treatment do RA patients encounter, and how do they vary across the two countries? 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 Mexico and Argentina? 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?