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Survey: U.S. Physicians and Payers Have Mixed Views on Arthritis Drug Tofacitinib (Xeljanz)

Payers employ cost-control measures to limit use of pricey RA treatments

Decision Resources Group, a health care research firm located in Burlington, Mass., finds that although 80% of surveyed rheumatologists currently prescribe tofacitinib (Xeljanz, Pfizer) for the treatment of rheumatoid arthritis (RA), the drug is usually used in later lines of therapy.

Physicians most frequently cited limited formulary coverage and reimbursement restrictions as reasons for not prescribing tofacitinib in earlier lines of treatment.

In addition, a notable proportion of surveyed rheumatologists considered the safety profile of tofacitinib to be inferior to that of the tumor necrosis factor (TNF)-alpha inhibitors, or they were not convinced that tofacitinib has a clinically meaningful effect on structural damage, although most of the physicians perceived the drug as being at least as effective as TNF-alpha inhibitors in treating the signs and symptoms of RA as well as in achieving remission.

Emerging oral and biologic agents will likely face challenges in obtaining formulary coverage and market uptake in the face of established biologics with extensive coverage, the report says.

Most of the surveyed rheumatologists indicted that they are prescribing intravenous golilumab (Simponi Aria, Janssen) and subcutaneous tocilizumab (Actemra, Roche) –– recently launched formulations of existing biologics.

Eighty percent of surveyed physicians intended to prescribe the emerging Jak inhibitor baricitinib (Eli Lilly/Incyte) within 2 years of availability. However, payers indicated that the agent must be offered at a large discount compared with tofacitinib for placement on a preferred tier.

About two-thirds of the surveyed rheumatologists anticipated prescribing biosimilar versions of adalimumab (Humira, AbbVie) and rituximab (Rituxan, Biogen Idec/Roche) within the first year of their availability. The size of the discount (compared with the brand) will affect the reimbursement of these agents, the report notes.

“Cost-related issues and safety reasons are the two equally common reasons non-Medicare patients who are candidates for biologics and Xeljanz are not being treated with these agents,” said analyst Ronnie Yoo, PhD. “There is room for improvement in the formulary coverage or drug coupon programs to make the premium-priced RA agents more affordable.”

Yoo added: “The majority of surveyed payers currently reimbursing Xeljanz indicated that the coverage of Xeljanz will not likely change despite the label expansion including structural damage data. However, a few plans may move Xeljanz to a lower tier following the label expansion, emphasizing the importance of structural data for the favorable tier placement of RA therapies.”

Source: Decision Resources Group; October 29, 2014.

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