Myelofibrosis (MF) is a hematological malignancy characterized by disrupted blood cell production and bone marrow scarring. Two high-priced JAK inhibitors (Incyte’s Jakafi and BMS’s Inrebic) are the only FDA-approved drugs to treat MF, leaving hematologists with limited options. Treatment costs are set to increase with expected approval of new therapies, including Sierra Oncology’s momelotinib and CTI BioPharma’s pacritinib, in the near future. We explore reimbursement of approved MF therapies in commercial and Medicare plans, MCO coverage of off-label therapies for MF, and the impact of reimbursement policies on hematologists’ use of MF therapies. In addition, this report assesses how U.S. hematologists and payers will react to new emerging therapies entering the market and how payer policies will affect hematologists’ adoption.
What is the current state of coverage of approved MF therapies (Jakafi and Inrebic) in the U.S. market? What restrictions do payers impose, and how do market access dynamics influence surveyed hematologists’ prescribing?
What factors drive MCOs’ favorable positioning of a drug on formulary? Have MCOs analyzed the cost-effectiveness of the approved therapies?
To what degree do MCOs cover the numerous off-label therapies that treat the symptoms of MF, and what conditions do they require for coverage?
What are physicians’ perception of the emerging agents, and how do payers anticipate covering these agents?
Release date: September 2021.
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 for MF therapies by commercial plans covering 162.7 million lives nationally and Medicare Part D plans covering up to 36.2 million lives.
Opportunities and challenges for emerging therapies.
Disease-specific special topic.
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.
Access & Reimbursement Myelofibrosis US September 2021
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.