If Tofacitinib is Priced at a 16 Percent or Greater Discount to Humira, at Least 45 Percent of Surveyed MCO Pharmacy Directors Will Place It On a Preferred Brand Tier, According to a New Report from Decision Resources
BURLINGTON, Mass.--(BUSINESS WIRE)-- Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that, if biosimilar versions of Amgen/Pfizer’s Enbrel were available after the launch of Pfizer’s oral janus kinase (Jak) inhibitor tofacitinib and were priced at a modest discount to branded Enbrel (and assuming tofacitinib were priced 30 percent less than Abbott’s Humira), of the patients who initiate tofacitinib in the second year after its launch (year-end 2014), surveyed rheumatologists estimate that 24 percent would be biologic-naive and 30 percent would have been previously treated with at least one TNF-alpha inhibitor.
The new U.S. Physician & Payer Forum report entitled Will the Launch of Emerging Oral Immunomodulators be a Game-Changer for the Rheumatoid Arthritis Market? also finds that if tofacitinib was priced at a 16 percent or greater discount to Humira, at least 45 percent of surveyed managed care organization (MCO) pharmacy directors will place the drug on a preferred brand tier during its first year on the market. MCOs were informed of the approximate annual cost of Humira therapy and were asked to assume that tofacitinib demonstrates efficacy similar to that of the TNF-alpha inhibitors and has an acceptable safety profile.
However, if presented with a higher price for tofacitinib (a discount of 1 percent to 15 percent to Humira), only 20 percent of surveyed pharmacy directors said their MCO would reimburse for tofacitinib on a preferred brand tier in their largest commercial plan. This higher price would drive more pharmacy directors to consider covering tofacitinib on a specialty tier; nearly half would do so at a discount of 16 to 25 percent to Humira versus more than two-thirds who would do so at a discount of 1 to 15 percent. If MCOs choose to use a specialty tier, beneficiaries could face higher copays and coinsurance to access tofacitinib.
The findings also reveal that the launch and uptake of the novel oral disease-modifying antirheumatic drugs (DMARDs) tofacitinib and the spleen tyrosine kinase (syk) inhibitor fostamatinib disodium, from AstraZeneca and Rigel, will reduce prescribing of non-TNF-alpha inhibitor biologics in the third and fourth lines of treatment in patients who fail conventional DMARDs.
“While a minority of surveyed rheumatologists expect to prescribe a novel oral DMARD in the first two lines following conventional DMARD therapy in 2014, prescribing of TNF-alpha inhibitors in early lines will be less affected than that of non-TNF-alpha inhibitor biologics,” said Decision Resources Therapeutic Area Director Madhuri Borde, Ph.D. “Currently, 23 percent of surveyed rheumatologists prescribe a non-TNF-alpha inhibitor biologic as a third-line biologic therapy in non-Medicare beneficiaries, only 15 percent will prescribe them in this line by the end of 2014.”
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Christopher Comfort, 781-993-2597
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