Myelodysplastic syndromes (MDS) are a heterogeneous collection of hematopoietic stem cell disorders that result in cytopenias. Based on our survey results, the U.S. reimbursement environment already restricts the prescription of high-priced MDS medications, and treatment costs are set to increase with the expected approval of new agents, including BristolMyers Squibb / Acceleron’s Reblozyl. In this report, we analyze in depth the current and anticipated uptake of MDS therapies. In addition, we examine how MCO formulary decisions and utilization controls on both the pharmacy benefit and medical benefit affect the prescribing of surveyed hematologists.
What is the coverage status of key MDS medications such as Vidaza, Revlimid, and the ESAs? What are the key drivers of their status?
How strong of an impact do reimbursement restrictions have on hematologists’ decision to use less-effective but more-affordable treatment options for MDS? What other factors influence prescribing?
Which are the key factors that payers consider before including a drug in their formulary? What changes do payers anticipate in the future?
What attributes must an emerging MDS therapy offer to secure favorable coverage and formulary positioning? What impact will luspatercept’s potential approval have on the MDS therapy market?
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.
Release date: June 2020
Geography: United States
Primary research: Survey of 100 U.S. hematologists and 30 U.S. managed care organization (MCO) pharmacy and medical directors (PDs / MDs).
Fingertip formulary: Formulary coverage and restrictions data for MDS therapies by commercial plans covering approximately 166 million lives and Medicare Part D plans covering 35 million lives nationally.
Access & Reimbursement Myelodysplastic Syndromes US June 2020
Rachit Singhal, M.Pharm.
Rachit Singhal, M.S., is an analyst on the Infectious, Niche, and Rare Diseases team at DRG, part of Clarivate. Prior to joining DRG, he was a consultant at IQVIA. He has experience in multiple areas of healthcare analytics, including digital analytics. He also has experience in stakeholder management, client liaising, and product management. Mr. Singhal obtained both his master and bachelor of pharmacy degrees from the Delhi Institute of Pharmaceutical Sciences and Research.
Chris Lewis is a primary research manager at Clarivate. She is responsible for the coordination, content review, and content generation of U.S. Access & Reimbursement reports, including authoring select A&R reports on managed care trends. Before this position, Ms. Lewis was a senior analyst at HealthLeaders-InterStudy. She analyzed the managed care markets in California, New York, and Pennsylvania. She also launched and authored the Pharmacy Benefit Manager profile series. She received her bachelor’s degree from California State University in Sacramento.