Axial Spondyloarthritis – Access & Reimbursement – Detailed, Expanded Analysis Axial Spondyloarthritis And Psoriatic Arthritis (China)

Introduction

The prevalence of spondyloarthritis is increasing in China, where the estimated number of total prevalent cases of ankylosing spondylitis (AS) exceeds 1.6 million. Although the total prevalence of psoriatic arthritis (PsA) in China remains low compared with the mature markets, the lack of new treatments and the recent entry of domestic biosimilars stress the importance of carefully positioning branded biologics by their manufacturer in order to maximize these agents’ potential. Our Access & Reimbursement analysis explores how market access barriers shape treatment for AS and PsA in China based on collective insight from 50 local rheumatologists and 3 payers with influence on reimbursement and access of key agents.

Questions Answered in This Report:

  • How does reimbursement status influence prescribing and how much does financial barriers limit the uptake of biologics for PsA and AS.
  • How might the new “free pricing” policy and “public hospital reform” in China affect the pricing and reimbursement of AS and PsA drugs.
  • The current drivers and barriers to prescribing of biologics for AS and PsA, and the main cost-related/clinical constraints to the uptake of these agents.
  • How does the availability of domestic etanercept biosimilars impact prescribing and what are physicians’ off-label prescribing patterns in AS and PsA.
  • How payers perceive biosimilars. Will their presence drive a price cut on the branded products and impact the reimbursement status of biologics.
  • Payers’ expectations for emerging therapies. How will market access barriers evolve and the challenges emerging therapies for AS and PsA are likely to face in the future.
  • How do rheumatologists expect to prescribe biosimilars and emerging agents and their likely impact on current brands over the next three years.

Scope:

Decision Resources Group’s Access and Reimbursement module in Axial Spondyloarthritis and Psoriatic Arthritis in China explores the prescribing patterns of current AS and PsA biologic therapies, the potential impact of the anticipated arrival of novel biologics and biosimilars, and key national and regional market access factors that will shape the use of biologics in China over the next two to three years. This report draws on insights from 50 surveyed rheumatologists and from interviews with three payers in China, all of whom have influence at a national or regional level.

Markets covered: China.

Primary research:

  • 50 rheumatologists.
  • 3 payers:
    • Panel Member for PRDL update, Shanghai
    • Panel Member for PRDL update, Jiangsu.
    • Drug Review Expert at CFDA, Beijing

Table of contents

  • Axial Spondyloarthritis - Access & Reimbursement - Detailed, Expanded Analysis Axial Spondyloarthritis And Psoriatic Arthritis (China)
    • Actionable Recommendations to Optimize Market Access
      • Optimizing Market Access Opportunity for New Biologic Therapies in China
    • Successes and Stumbles
      • Successes Among AS and PsA Biologic Therapies in China
      • Stumbles Among AS and PsA Biologic Therapies in China
      • China: Reimbursement/Coverage Successes & Stumbles
        • China: Reimbursement Successes and Stumbles Among AS and PsA Biologics
    • Key Stakeholders in the Road to Market Access
      • China
    • Key Market Access Roadblocks
      • Key Market Access Roadblocks for AS and PsA Biologic Therapies in China
    • Reimbursement Dynamics
      • China: Reimbursement Dynamics for Ankylosing Spondylitis and Psoriatic Arthritis
        • China: Drivers of Formulary Coverage
        • China: Reimbursement Details for Key AS and PsA Biologics
        • China: Key Background Details of the Healthcare System
        • China: P&R Process
        • China: Impact of Hospital Reform on Access to Patent Drugs
        • China: Impact of Hospital Reform on Access to Patent Drugs
        • China: Payer Opinions on Prescribing Practices
        • China: Patient Assistance Programs
        • Patients Assistance Programs for AS in China
        • Patients Assistance Programs for AS in China
        • China: Off-Label Prescribing for PsA
        • Payer Insights on Biosimilars
    • Pricing and Reimbursement, Policy, and Coverage: Impact on Prescribing
      • Prescriber Preferences for AS
        • Patient Share of Current TNF-u03b1 Inhibitors for AS
        • Most-Prescribed Agents: Rheumatologists' Current Choice of Biologic for AS After Failure of Conventional DMARDs
        • Most-Preferred Agents: Rheumatologistsu2019 Choice of TNF-u03b1 Inhibitor for AS in a 100% Reimbursement/Restriction-Free Environment
      • Prescriber Preferences for PsA
        • Prescriber Patterns Among Current TNF-u03b1 Inhibitors
        • Prescriber Preferences Among Current TNF-u03b1 Inhibitors After DMARD Failure
        • Prescriber Preferences Among TNF-u03b1 Inhibitors in a 100% Reimbursement/Restriction-Free Environment
      • Impact of Payer Policy on Prescribing for AS and PsA
        • Patients Not Receiving Biological Therapy due to Lack of Reimbursement/Funding/Budget Restrictions
        • Biologic Inclusion into PRDL and Reimbursement Rate
      • Top Prescribing Drivers: AS and PsA
        • Drivers of Choice of Enbrel or Etanercept Biosimilars as the First TNF-u03b1 Inhibitor for AS
      • Payer Policy Uptake Constraints
        • Impact of Market Access Constraints, Payer Policies, and Budget Restrictions on the Uptake of Biologic Therapy
      • Key Levers and Constraints on Current Therapies
      • Market Access Landscape for Emerging Therapies
        • Likely Impact of Emerging Therapies on AS and PsA
          • Estimated Patient Shares of TNF-Alpha Inhibitors for PsA and AS by 2019
          • Physician Prescription Preference Following DMARD Failure by 2019
        • Likely Impact of Emerging Biosimilars on AS and PsA
          • Likely Impact of Emerging Biosimilars on Current Brand Use
        • Market Access Challenges for Simponi for AS
          • Impact of Biosimilars on Brand Prescribing
          • Rheumatologists' Expectations for Biosimilar Pricing
        • Payer Opinion on Emerging Therapies for AS and PsA
        • Appendix
          • Commercial Context
            • China: Diagnosed Prevalent Cases of Ankylosing Spondylitis and Psoriatic Arthritis
            • Treatment Algorithm for Psoriatic Arthritis in China
            • Treatment Algorithm for Ankylosing Spondylitis in China
            • Profiles of Key Biologics for Ankylosing Spondylitis and Psoriatic Arthritis in China
            • Advantages and Disadvantages of Select Biologics for Ankylosing Spondylitis and Psoriatic Arthritis
            • Daily Cost of Select Biologics
            • Timeline of Approvals of Key Current and Emerging Therapies
            • Simponi
            • Janssen's Simponi (Golimumab)
          • Physician Survey Data
            • Percentage of AS/PsA Patients with Commercial Insurance Coverage
            • Type of Benefits for AS/PsA Patients Conferred by Commercial Insurance Coverage
            • Percentage of AS/PsA Patients Receiving Western Drug Treatment
            • Percentage of AS/PsA Patients Receiving Western Drug Treatment by Drug Class
            • Location of Administration for SC Biologics
            • Patient Share of TNF-u03b1 Inhibitors in PsA and AS
            • Most-Used Biologics for PsA After Failure of Conventional DMARDs, by Line of Therapy
            • Most-Used Biologics for AS After Failure of Conventional DMARDs, by Line of Therapy
            • Reasons for Prescribing Top Biologic for AS
            • Reasons for Prescribing Select Biologics for AS
            • Percentage of Patients Discontinuing Treatment due to Nonclinical Reasons
            • Percentage of Patients Not Receiving Biologic Treatment due to Reimbursement/Funding/Budget Restrictions
            • Reimbursement/Funding/Budget Issues Limiting the Prescribing of TNF-Alpha Inhibitors for Eligible PsA and AS Patients
            • Reimbursement/Funding/Budget Issues Limiting the Off-Label Prescribing of Non-TNF-Alpha Inhibitors for PsA
            • Most-Preferred Biologic for PsA and AS
            • Government Insurance (PRDL) Coverage of Immunobiologics
            • Reimbursement Rate for PRDL-Covered Immunobiologics
            • Copayment Restriction to the Prescribing of PRDL-Covered Immunobiologics
            • MabThera's Lack of PsA Label as a Restriction to Reimbursement for PsA
            • Most Common Patient Access Routes to Biologics for PsA (Off-Label)
            • Most Common Patient Access Routes to Uncovered Immunobiologics
            • Possibility of PRDL Inclusion of Immunobiologics in Next Update
            • Rheumatologistsu2019 Preferences Regarding NRDL Inclusion of Immunobiologics
            • Reasons for Not Including Immunobiologics in the NRDL
            • Medicine Rate Targets
            • Impact of Medicine Rate Target on Prescribing of Immunobiologics for AS and PsA
            • Impact of Zero Markup Policy on Prescribing of Immunobiologics for PsA and AS
            • Adherence to Patient Assistance Programs for Biologics for AS
            • Factors Limiting Participation in Patient Assistance Programs
            • Impact of Biosimilars on Brand Prescribing
            • Rheumatologists' Expectations for Biosimilar Pricing
            • Delays in the Prescribing of Biosimilars to PsA and AS Patients
            • Percentage of Biologic-Naive PsA and AS Patients Started on a Biosimilar, One Year After the Biosimilaru2019s Launch
            • Percentage of Biologic-Treated PsA and AS Patients Switched to a Biosimilar, One Year After the Biosimilaru2019s Launch
            • Prescribing of Branded Biologics After Failure of Treatment with the Respective Biosimilar
            • Patient Shares of Select Brand vs. Biosimilar Biologics for PsA and AS by 2019
            • Rheumatologistsu2019 Reasons for Not Prescribing Biosimilars
            • Prescribing Drivers for an Emerging Therapy as a First-Line Biologic
            • Rheumatologists' Perceived Advantages of Simponi vs. Currently Marketed TNF-Alpha Inhibitors
            • Estimated Patient Share of DMARDs for PsA and AS by Drug Class, by 2019
            • Estimated Patient Share of TNF-Alpha Inhibitors for PsA and AS by 2019
            • Agent Most Likely to Be Prescribed to DMARD-Refractory PsA Patients by Line of Therapy, by 2019
            • Agent Most Likely to Be Prescribed to DMARD-Refractory AS Patients by Line of Therapy, by 2019
            • Factors Limiting Uptake of Emerging Therapies for PsA and AS Patients

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