Dry Eye – Access & Reimbursement – Detailed, Expanded Analysis (US)
For more than a decade, AbbVie’s Restasis was the only FDA-approved therapy for dry eye disease (DED) until the launch of Novartis’s Xiidra in 2016, followed by Restasis MultiDose, Sun Ophthalmics’ Cequa, Alcon’s Eysuvis, and, more recently, Oyster Point’s Tyrvaya. In addition to these drugs, off-label ophthalmic corticosteroids and antibiotics are often prescribed for DED. Competition has further increased with the launch of the first generics of Restasis in February 2022 and will continue to increase with the expected near-term launch of other late-stage agents, particularly Aldeyra’s ADX-102 and Novaliq’s CyclASol. Because treatment burden plays a critical role in the management of DED, it is important to understand the preferences and expectations of physicians and payers regarding approved and emerging therapies. This report explores drivers of physicians’ and payers’ prescribing and coverage decisions and their receptivity to emerging agents for DED. These preferences dictate prescribing trends and patient access to DED therapies, ultimately shaping the future treatment landscape and market dynamics.
QUESTIONS ANSWERED
- Does coverage of key DED brands differ on MCOs’ largest Medicare Part D and commercial insurance plans?
- What are the current prescribing practices for DED, and how are they impacted by payer policy?
- How receptive are payers to drugs in late-stage development for DED? What coverage decisions do they anticipate? How do ophthalmologists and optometrists expect to prescribe the agents?
- How do payers’ utilization management strategies impact physicians’ prescribing of approved DED therapies, and how is generic Restasis, launched in the United States in February 2022, prescribed and reimbursed for DED?
CONTENT HIGHLIGHTS
Geography: United States
Primary research: Survey of 100 U.S. ophthalmologists and optometrists, survey of 30 U.S. MCO PDs / MDs
Fingertip formulary: Formulary coverage and restrictions data for DED therapies by commercial plans covering approximately 163.6 million lives and Medicare Part D plans covering 36.7 million lives nationally.
Key drugs covered: Restasis, Restasis MultiDose, Xiidra, Cequa, Klarity-C, Eysuvis, Tyrvaya, CyclASol, NOV03, RGN-259, ADX-102
Content highlights:
Reimbursement and contracting.
Access and prescribing.
Opportunities and challenges for emerging therapies.
Disease-specific special topic.
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.
Table of contents
- Dry Eye - Access & Reimbursement - Detailed, Expanded Analysis (US)
- Access & Reimbursement | Dry eye disease | US | June 2023
Carolina Ruivo, Ph.D., Healthcare Research & Data Analyst, CNS and Ophthalmology. Dr. Ruivo’s focus is the ophthalmology market. Previously, she was a content specialist in Cortellis, the suite of life science intelligence solutions from Clarivate. She holds a Ph.D. in biomedical sciences from Pompeu Fabra University in Barcelona, Spain, and a B.S. in biology from the University of Aveiro in Portugal.
Chris Lewis, Lead Healthcare Research & Data Analyst, U.S. Access and Reimbursement. Ms. Lewis oversees Clarivate’s U.S. Access & Reimbursement reports, including managing the primary research activities, reviewing content, and authoring select A&R reports on managed care trends. A Clarivate employee for 16 years, Ms. Lewis previously was a senior analyst who authored Health Plan Analysis reports and PBM profiles. She received her bachelor’s degree from California State University in Sacramento.