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Survey: Both Physicians and Payers Are Sensitive to Risk of Next-Day Impairment With Insomnia Therapies

Highest level of unmet need ascribed to insomnia treatments with reduced risk of abuse, tolerance

According to a survey conducted by Decision Resources Group, a health care research firm located in Burlington, Mass., U.S. and European psychiatrists identified the highest level of unmet need in insomnia treatment to be for new therapies with a reduced risk of abuse and tolerance.

Several currently available insomnia therapies are designated as controlled substances because of their potential for abuse, and interviewed thought leaders acknowledged abuse potential as a factor they consider when making prescribing decisions for insomnia.

Although other available insomnia drugs are not controlled substances, surveyed psychiatrists identified reduced risks of abuse and tolerance as an area of differentiation for new treatments. However, given that the insomnia market is highly genericized, an emerging therapy will have to offer significant improvements in safety and efficacy, not only in abuse potential, to penetrate the market, the report says.

In other key findings, clinical data and the opinions of interviewed thought leaders indicate that suvorexant (MK-4305, Merck) may offer clinical advantages over eszopiclone (Lunesta, Sunovion Pharmaceuticals) in terms of safety and tolerability, specifically a lower incidence of psychomotor events and of residual next-day effects at the doses deemed approvable.

In addition to the need for a therapy with a reduced risk of abuse and tolerance, surveyed psychiatrists identified a significant unmet need for therapies associated with reduced residual next-day side effects, such as residual sedation. This finding is consistent with insight from interviewed sleep experts, who called for a novel insomnia medication with a more favorable pharmacokinetic profile, resulting in a reduced frequency of next-day side effects.

Surveyed pharmacy directors at U.S. managed care organizations were receptive to reimbursing a novel insomnia therapy offering improvements in time awake after sleep onset and in the number of patients reporting next-day sleepiness, but they would require 100% or more improvement in these metrics over that attained by current therapies. Treatments offering such robust benefits could command a premium price in the market, but payers would control costs by requiring step therapy and prior authorization.

“The potential for a patient to develop abuse and tolerance with insomnia medications is a concern among interviewed psychiatrists, who take this risk into consideration when prescribing an insomnia therapy,” said analyst Tamara Blutstone, PhD. “Reduced risk for tolerance or dependence is an area where surveyed payers express a high willingness to grant favorable formulary status for a new insomnia therapy and where surveyed physicians identify unmet need in insomnia treatment.”

Source: Decision Resources Group; April 2, 2014.

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