Axial Spondyloarthritis – Access & Reimbursement – Detailed, Expanded Analysis Axial Spondyloarthritis and Psoriatic Arthritis (Brazil & Mexico)


The prevalence of psoriatic arthritis (PsA) and ankylosing spondylitis (AS) in Brazil and Mexico is estimated at 1.3 million and is expected to keep growing. The entry of biosimilars and the upcoming arrival of novel therapies for PsA and AS are shaping a new therapeutic landscape in Brazil and Mexico, which is currently dominated by the long established TNF-alfa inhibitors.In this Access& Reimbursement analysis, we discuss the current access landscape to PsA and AS treatments in Brazil and Mexico and the expected future uptake of biosimilars and key emerging therapies (e.g., Novartis’s Cosentyx, Janssen’s Stelara, Celgene’s Otezla)— and the levers and roadblocks to their uptake—based on primary research with rheumatologists and payers in these two countries.

Questions Answered in This Report:

  • Explore current and evolving drug coverage and prescribing trends. How does coverage of approved biologics vary between countries and public and private settings? What are the most prescribed and the preferred biologics for the treatment of PsA and AS, by line of treatment? What are the key drivers for the prescribing of a specific biologic over others? How do cost/reimbursement-related constraints outline prescribing patterns? How do payers perceive biosimilars? Will their presence drive a price cut on the branded products and impact the reimbursement status of biologics? How does the availability of etanercept and infliximab biosimilars impact prescribing and what are physicians’ off-label prescribing patterns in AS and PsA.
  • Explore the outlook for emerging agents for PsA and AS. What are payers’ attitudes toward emerging agents? How do payers expect access to premium-priced agents to evolve in the next three years? What market access obstacles will these novel therapies face? Which clinical and coverage opportunities can drug developers benefit from to better position their products in these markets? What role will head-to-head and pharmacoeconomic outcomes play in the coverage of novel agents versus current standards of care? How will prescribing patterns evolve with the availability of novel agents? How do rheumatologists expect to prescribe biosimilars and emerging agents and their likely impact on current brands over the next three years?


For this Access & Reimbursement module on PsA and AS, we surveyed 105 rheumatologists and interviewed 6 payers to explore the current and future dynamics in the use and coverage of premium-priced PsA and AS therapies in Brazil and Mexico. Interviewees have regional or national influence or inform regulations on AS and PsA.

Markets covered: Brazil, Mexico.

Primary research:

  • 105 rheumatologists.
  • 3 payers in Brazil: Member of the National Committee for Incorporation of Technologies in the Health System (CONITEC) for 3 years, current Ad-hoc consultant for MoH, nurse and specialist in pharmacoecomics; 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.
  • 3 payers in Mexico: Coordinator of the Nacional 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.

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