Systemic Lupus Erythematosus | Access and Reimbursement | US | 2020

The systemic lupus erythematosus (SLE) therapy market in the United States is largely genericized and off-label. With the exception of GlaxoSmithKline’s Benlysta—which launched in 2011—no new drug has been approved for this indication in almost 60 years. Because Benlysta (IV and SC) is an expensive, branded biologic, access to it is typically restricted by payers. Several therapies are in late-phase development for SLE, including agents targeting a previously underserved subpopulation of SLE patients—active lupus nephritis (LN). This report examines the prescribing and reimbursement environment for Benlysta (IV and SC) and emerging SLE agents in the United States, according to surveyed rheumatologists and MCO PDs / MDs. The content explores how physicians and payers perceive current and emerging SLE therapies and the reimbursement dynamics that will promote or restrict market access to the agents.


· What is the extent of MCO coverage of Benlysta and an off-label Rituxan, and how do the coverage policies affect rheumatologists’ prescribing of these drugs?

· Will approval of Benlysta for LN affect its coverage on commercial plans? How do rheumatologists perceive Benlysta for LN?

· How do physicians anticipate using treatments in development for moderate to severe nonrenal SLE (e.g., anifrolumab, baricitinib), and how do payers expect to cover these therapies on commercial plans?

· What is the potential reimbursement picture for therapies in development for LN (e.g., voclosporin, obinutuzumab), and where in the treatment algorithm do physicians anticipate using them?

PRODUCT DESCRIPTION U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.

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