Formulary Advantages in Analgesics for Chronic Pain: How will emerging reformulations and fixed-dose combinations fare among U.S. health plans?

Chronic pain syndromes of neuropathic, nociceptive and mixed origins cause substantial human suffering and disability. Despite the number of pain therapies marketed in the U.S., there remains an unfilled need for drugs that provide improved efficacy, safety and tolerability. Branded reformulations and fixed-dose combinations of previously marketed active molecules provide increased convenience, safety and tolerability for patients; however, health plans often have difficulty gauging the value of these qualities, especially when efficacy is equivalent, compared with the lower cost-burden of generic alternatives. Further, the subjective nature of assessing pain outcomes, compared with other conditions that are monitored by laboratory testing and imaging, and increasing brand crowding within the pain market means that marketers bear a greater responsibility to differentiate the value of their drug to health plans in order to receive widespread reimbursement.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 47 pharmacy directors, this report determines the key trends in reimbursement of analgesics for chronic pain, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition and provides insight for stakeholders looking to capitalize on future shifts in coverage in order to better position their products among competitors.