Surveyed Dermatologists Estimate that Half of Psoriasis Patients Who are Treated with Janssen Biotech/Janssen-Cilag's Stelara Have Previously Failed Treatment with at Least One TNF-Alpha Inhibitor
Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that, for the treatment of psoriasis, surveyed dermatologists estimate that half of patients who are treated with Janssen Biotech/Janssen-Cilag's Stelara have previously failed treatment with at least one TNF-alpha inhibitor. The 27 percent of patients who have failed one anti-TNF agent and the 20 percent who have failed two likely reflect the position of Amgen/Pfizer/Takeda/Stiefel’s Enbrel and Abbott/Eisai’s Humira as the early-line therapies.
The new U.S. Physician & Payer Forum report entitled also finds that more than one-third of surveyed dermatologists who cited step therapy restrictions on Stelara indicated that payers typically require patients to fail at least one TNF-alpha inhibitor, emphasizing that even if physicians felt comfortable prescribing Stelara as a first-line biologic, in some cases reimbursement constraints would not allow it.
The report also finds that while the approved psoriasis biologics that have been marketed the longest and have multiple indication approvals (including rheumatoid arthritis and psoriatic arthritis) are not commonly excluded or blocked under the National Drug Code (NDC) from surveyed commercial plans, Stelara is excluded/NDC blocked from 35 percent of these plans. As a result, surveyed managed care organizations’ (MCOs) pharmacy directors are excluding Stelara from their formularies despite the fact it has shown superior efficacy to Enbrel in a Phase III clinical trial and carries a similar price per treated day (for the 45 mg dosing regimen) as the subcutaneous TNF-alpha inhibitors.
“Prior authorization is cited by surveyed MCO pharmacy directors as the most common utilization control imposed on the biologics they reimburse,” said Decision Resources Therapeutic Area Director Madhuri Borde, Ph.D. “Among the few surveyed pharmacy directors who reported that they utilize step therapy protocols for granting access to biologic therapy, the most common requirements for use of Enbrel and Humira is failure with topical agents, phototherapy and/or two or more oral systemic therapies.”
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