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High Cost of Biologics and Novel Oral Agents to Treat Immune Diseases Limits Patient Access
Date:12/10/2013

BURLINGTON, Mass., Dec. 10, 2013 /PRNewswire/ -- Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that the high cost per patient per year of biologics and novel 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 United States who are eligible but do not receive a biologic/novel oral therapy (approximately 10 percent of disease-modifying antirheumatic [DMARD]-treated RA patients), more than 35 percent do not receive treatment because of cost-related issues, and approximately 20 percent do not receive treatment because of payer restrictions.

The new Strategic Insights report entitled Trends in Reimbursement for Immune Biologics: Strategies for Success also finds that in an attempt to control the increasing costs associated with biologics/novel oral agents, particularly the non-TNF-alpha inhibitors, payers frequently use a wide range of strategies and tactics such as prior authorization, step-therapy requirements and blocking copay assistance programs for nonpreferred 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 Decision Resources Analyst Adi Reske, Ph.D. "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."

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