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Survey: Up to 60% of U.S. MCO Directors Expect to Cover Emerging Therapies for Parkinson’s Disease

At least one-quarter of diagnosed patients would be eligible for emerging products (August 19)

Decision Resources, a research and advisory firm located in Burlington, Mass., finds that up to 60 percent of surveyed U.S. managed care organization (MCO) pharmacy and medical directors expect to reimburse several late-stage emerging Parkinson’s disease (PD) therapies on their largest risk-based commercial plan.

The report profiles four emerging agents that target primarily under-served populations: Rytary (IPX-066, Impax Laboratories), an extended-release reformulation of levodopa, the mainstay of PD treatment; pimavanserin (Acadia Pharmaceuticals) for PD-related psychotic symptoms; mavoglurant (AFQ-056, Novartis) for dyskinesias; and safinamide (Newron Pharmaceuticals/Zambon Pharma), a monoamine oxidase-B (MAO-B) inhibitor.

The report finds that formulary exclusion can be common for current PD brands, with at least one-third of MCO respondents indicating that their largest commercial plans and Medicare prescription drug plans exclude or block key brands from coverage. The most recent market entrant, the dopamine agonist rotigotine (Neupro, UCB), is similarly covered, despite offering once-daily dosing and unique transdermal delivery.

Nevertheless, when reimbursing key current brands, surveyed payers largely include such agents on tiers 2 and 3 (commonly preferred and non-preferred brands, respectively), and generally expect similar tier placement for the emerging agents profiled if priced at approximately $10 per day or higher.

The report also finds that surveyed neurologists estimate the eligible patient pool for emerging products queried to be no less than one-quarter of their diagnosed PD patients, on average. Moreover, they anticipate that up to two-thirds of eligible patients would be treated with each product within 1 year of launch, with Rytary projected to capture the greatest patient share at approximately 25 percent of diagnosed PD patients if reimbursed on a preferred tier.

“Cost and reimbursement factors have a prominent role in determining the uptake of a PD therapy, but clinical considerations most influence prescribing decisions,” said analyst Nadja Rozovsky, PhD. “Despite the potential for certain constraints on reimbursement and finite patient eligibility, commercial opportunity remains for key late-stage investigational products in light of lingering unmet need.”

Source: Decision Resources; August 19, 2013.

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