Formulary Advantages in Chronic Pain Therapies: How Will Price Impact the Coverage of Expensive Abuse-Deterrent Opioids and Biologics?

Chronic pain is a multi-billion dollar market saturated with well-established branded and generic analgesics that are only partially effective. While drugs with novel mechanisms of action that offer greater efficacy will contribute to market growth, reformulations of current therapies that offer improved convenience, tolerability, or abuse-deterrence will inevitably be more expensive than current generics and will likely replace low-cost generics only in specific niche populations. New agents such as Pfizer’s tanezumab, the first biologic to treat chronic pain, and King’s Embeda (morphine SR and naltrexone), the first abuse-deterrent opioid analgesic on the U.S. market, address unmet needs in the chronic pain market. However, managed care organizations (MCOs) will seek to limit these agents’ use to specific patient populations to control the cost of these expensive therapies.

Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of chronic pain treatments, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.