Chronic Pain | Physician & Payer Forum | US | 2015

U.S. Physician and Payer Insights on New and Recently Launched Therapies and on the Impact of Expanding Generics
The chronic pain market is sizeable in terms of both dollars and the potential patient pool; however, the current and forthcoming availability of multiple generic versions of early-line analgesics as well as the entrenchment of available treatment options in current medical practice present notable barriers to market penetration of new drugs. Nevertheless, mainstay treatments for most chronic pains—NSAIDs and opioid analgesics—are associated with significant cardiovascular and gastrointestinal side effects and the risk of abuse, respectively; these safety/tolerability risks negatively impact patients’ quality of life, especially when prescribed over the long term. In recent years, there have been several important treatment advances and regulatory approvals to address unmet need in the chronic pain space, most notably, the launch of several long-acting opioid analgesics that feature abuse-deterrent properties that make the products more difficult to abuse via certain routes of administration. The launch of these therapies, as well as the recent and potential forthcoming entry of other analgesics—many of which are alternative formulations of already-available molecules—has created and will continue to create an increasingly complex treatment landscape.

The changing treatment environment for chronic pain will continue to present to physicians and payers the challenge of considering each new therapy’s unique balance of benefits, drawbacks, risks, and rewards when making treatment and formulary decisions. Because emerging therapies will be entering a crowded and mature analgesic market, they will need to demonstrate clear clinical advantages (e.g., improved safety), in addition to pharmacoeconomic benefits (e.g., cost-effectiveness), compared with current therapies, if they are to attain price premiums, secure favorable formulary coverage, and garner any material share of this pain market. Furthermore, the ever-tightening reimbursement environment in the United States, coupled with the burgeoning number of available pain therapies—many of which are generically available and well established—and the growing number of opioid analgesics that feature abuse-deterrent properties will result in increased market access challenges for novel therapies. Although physicians may acknowledge the advantages of emerging pain therapies, treatment decisions will ultimately be driven by formulary coverage and tier placement; therefore, securing favorable reimbursement will be critical to ensuring uptake in the chronic pain market.

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