Psoriasis Pricing, Reimbursement, and Access

Report
96 Pages
March 2019
Region: Global
Citeline
ID: 4846136

Overview
Launch of multiple IL inhibitors with impressive efficacy has significantly reduced unmet need in the disease, and also provided payers with leverage in price negotiations as they seek to control growing treatment cost.

Key Questions Answered

What access controls are payers imposing on biologics in psoriasis?
How are biosimilar TNFs impacting the current and future market access for branded drugs?
In which markets are payers most likely to leverage growing competition to reduce treatment costs?
Which attributes will pipeline agents need to demonstrate to gain competitive advantage in a saturated biologics market?
What are payer and physician views on the need for further oral therapies?

OVERVIEW

REGULATORY LABELS

Marketed psoriasis products in the US, Japan, and five major EU markets
Bibliography

GLOBAL ACCESS LEVERS

Spend on psoriasis biologics is a particular concern for payers
High prices of biologics are leading to access barriers and pressure to offer discounts
Payers use tenders, physician incentives, and formulary exclusions to drive biosimilar uptake
Payers prefer straight discounts to outcomes-based risk agreements

EVIDENCE AND VALUE

Payers and physicians regard PASI and DLQI as the most important endpoints
Limited scope for differentiation of new agents based on PASI or DLQI
Providing treatment holidays or drug-free remissions could differentiate future pipeline treatments
Head-to-head trials with active comparators are critical in establishing differentiation
Minimum efficacy data of six months needed for good formulary access
Six-monthly or annual maintenance dosing regimens may be advantageous for pipeline agents
Cardioprotective effect of interleukins remains speculative, but data are welcome
Real-world evidence could be used to bolster local or regional positioning in the treatment algorithm

ACCESS TO RECENTLY APPROVED AND PIPELINE DRUGS

IL-17 and IL-23 inhibitors are viewed as more efficacious drugs, but TNF-alpha inhibitors will remain first-line biologics
IL-23 agents exhibit impressive efficacy but struggle to achieve preferred access versus IL-17s
Payers plan to leverage growing competition in the interleukin space through local or regional discounts or contracts
Tremfya’s superiority results against Cosentyx will drive prescribing but not pricing or formulary access
Siliq’s prospects remain poor, despite no correlation to suicide
Dosing frequency is not an important point of differentiation
Weaker PASI scores dampen Ilumya’s access prospects
Risankizumab’s strong efficacy data boost access prospects, but there is limited scope for a price premium
Moderate appetite for an oral inhibitor competitor to Otezla in psoriasis

PRICING

Insights and strategic recommendations

CANADA

Insights and strategic recommendations

JAPAN

Insights and strategic recommendations
Japan’s pricing strategy is reliant on pricing premiums for innovative medicines
Bibliography

FRANCE

Insights and strategic recommendations
ASMR rating has an impact on pricing
Bibliography

GERMANY

Insights and strategic recommendations
Positive assessment from the G-BA will impact price negotiations
Bibliography

ITALY

Insights and strategic recommendations
Bibliography

SPAIN

Insights and strategic recommendations
National reimbursement decisions are not a major access barrier in Spain
Regional access to psoriasis medicines varies in Spain
Bibliography

Insights and strategic recommendations
NICE approval is a key market access barrier
Bibliography

METHODOLOGY

Primary research
Price assumptions
Exchange rates
Bibliography

LIST OF FIGURES

Figure 1: Price sources and calculations for the US and EU, by country

LIST OF TABLES

Table 1: Marketed products and approved indications for psoriasis in the US, Japan, and five major EU markets
Table 2: Biosimilar access levers in the US and five major EU markets
Table 3: Levers impacting access to psoriasis drugs in the US and five major EU markets
Table 4: Summary of important key endpoints in psoriasis clinical trial design
Table 5: National reimbursement decisions for marketed and assessed ILs
Table 6: Contracting and financial agreements for interleukins
Table 7: Likely reimbursement for Ilumya in psoriasis
Table 8: Likely reimbursement for risankizumab in psoriasis
Table 9: Pricing of key psoriasis drugs in the US, Japan, and five major EU markets, by country, 2019
Table 10: Pricing premiums given to medicines in Japan that can demonstrate benefit over comparators
Table 11: Transparency Committee’s ASMR ratings and pricing implications
Table 12: Transparency Committee's SMR ratings and pricing implications
Table 13: Spanish Society of Hospital Pharmacy ratings
Table 14: Exchange rates used for calculating drug prices

Table of Contents

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