Ulcerative Colitis & Crohn’s Disease | Access and Reimbursement | US | 2019

TNF-α inhibitors are well entrenched in the U.S. ulcerative colitis (UC) and Crohn’s disease (CD) markets. Newer biologics that offer alternative treatment options (i.e., Takeda’s Entyvio and Janssen’s Stelara) as well as the increasing penetration of biosimilar infliximab (e.g., Pfizer’s Inflectra) continue to expand the UC/CD treatment landscapes. The launch of Xeljanz in 2018, the first oral agent and first JAK inhibitor in UC, will further shift UC market dynamics. Additionally, the arrival of emerging agents—some with novel MOAs—including Gilead/Galapagos’s filgotinib, Celgene’s ozanimod, and Roche’s etrolizumab, and the increasing physician prescribing of biosimilars will fuel competition and add to pricing pressure. Emerging therapies seeking favorable uptake in UC and/or CD will face a growing number of market access challenges.


  • How do MCO restrictions impact physicians’ prescribing of biologics/oral targeted agents to their UC or CD patients?
  • What is the current and expected formulary placement of key biologics/oral targeted agents (e.g., Xeljanz), and how are utilization management strategies used by MCOsto control costs of these agents?
  • How do payers expect to cover emerging therapies on their commercial health plans at various price points, and how does this coverage align with physicians’ anticipated prescribing of these agents?


Geography: United States.

Primary Research: Survey of ~100 U.S. gastroenterologists and ~30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs/MDs).

Key Drugs Covered: Remicade, Humira, Biosimilar infliximab, Simponi, Cimzia, Entyvio, Stelara, Xeljanz.

Content highlights: Reimbursement and contracting; access and prescribing; special topics; opportunities and challenges for emerging therapies.


U.S. Access & Reimbursement provides in-depth insight on the impact of payer policy on prescribing behavior so that clients can build their market access strategy and optimize their brand positioning. This analysis of primary market research with physician specialists and U.S. payers helps clients stay up-to-date on restriction policies, gauge payer and prescriber attitudes toward specific therapies, identify opportunities where brands can capture patient share through market access, and maximize opportunities for emerging therapies by learning how previous brands gained favorable reimbursement or why they stumbled.

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