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Survey: Unmet Need Exists for New Targeted Asthma Treatments

A quarter of patients with severe persistent asthma are refractory to current therapies

Decision Resources Group, a health-care research firm located in Burlington, Mass., finds that surveyed physician specialists will welcome the proliferation of asthma therapies that are poised for U.S. launch by 2018, and they anticipate using more-convenient once-daily therapies and novel biologic agents to manage their patients with asthma.

Surveyed payers and specialists — including pulmonologists and allergists — indicated particular enthusiasm for novel biologics that target patients with more-severe asthma, the report says. Surveyed specialists identified up to a quarter of their severe asthma patients as being refractory to existing medications, and more than 80% of physicians and pharmacy directors at managed care organizations (MCOs) highlighted at least a modest unmet need for novel therapies for treating this population.

According to the survey, clinicians anticipate that in-development novel interleukin-5 (IL-5) monoclonal antibodies — including reslizumab (Cinquil, Teva), mepolizumab (Bosatria, GlaxoSmithKline), and benralizumab (AstraZeneca) — will help to meet this unmet need. Clinical trials have shown that all of these novel IL-5 antagonists offer improvements in lung function or exacerbation rates. However, driven by positive phase III results in reducing the frequency of exacerbations, physicians and payers viewed mepolizumab as the agent that will best address unmet needs in this population.

The frequency of exacerbations is high among patients with severe, refractory asthma, and efficacy in reducing exacerbations will have a positive effect on prescribing and reimbursement, the report notes. Many surveyed payers viewed biologics as cost-effective in reducing hospitalizations and exacerbations. However, many were concerned about the cost of eosinophil testing to identify candidates and responders to IL-5 antagonist therapy.

The report’s findings also suggest that increases in the anticipated price of the new IL-5 antagonists will drive increased formulary exclusion and National Drug Code (NDC) blocking of these agents among surveyed MCO pharmacy directors’ and medical directors’ plans.

“Pricing strategies will be key to formulary inclusion, particularly for new biological agents,” said analyst Matthew Scutcher, PhD. “Additionally, because of the difference in cost between biological agents and the small-molecule agents currently prescribed in early lines of therapy for asthma, developers of emerging biological agents should consider co-pay reduction strategies for their therapies, particularly if payers make these agents non-preferred.”

Nearly all surveyed payers indicated that new therapies will commonly face cost controls, such as prior authorization and step therapy.

Source: Decision Resources Group; June 3, 2014.

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