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Report: High Cost of Biologics and New Oral Agents to Treat Immune Diseases Limits Patient Access

Drug marketers expected to face increasing payer restrictions (December 10)

Decision Resources, a research and advisory firm for pharmaceutical and health care issues, finds that the high cost per patient per year of biologics and new oral therapies for the treatment of rheumatoid arthritis (RA) and psoriasis often results in reimbursement hurdles that limit patients’ ability to access these therapies.

Among RA patients in the U.S. who are eligible for but do not receive a biologic or novel oral therapy, more than 35% do not receive treatment because of cost-related issues, and approximately 20% do not receive treatment because of payer restrictions.

The report also finds that, in an attempt to control the increasing costs associated with biologics and new oral agents, particularly the non–tumor necrosis factor (TNF)-alpha inhibitors, payers often use a wide range of strategies and tactics, such as prior authorization, step-therapy requirements, and blocking copay assistance programs for non-preferred agents.

“As new biologics, novel oral agents, and biosimilars enter the RA and psoriasis markets, drug marketers can expect more payer scrutiny and restrictions,” said analyst Adi Reske, PhD. “Payers will demand extensive data and greater discounts and rebates to justify giving a therapy preferred coverage. To overcome the increasing barriers, drug marketers must employ different strategies, including more cost-effective agents, head-to-head clinical data, and greater discounts and rebates.”

Source: Decision Resources; December 10, 2013.

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