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Managed Markets Insights

Perspectives on Medical Therapy Access, Reimbursement and Payer Influences

Trends in Psoriasis Payer Management

The psoriasis marketplace has grown significantly in the last couple of years with newer agents being approved. With a new set of biologics entering the market, psoriasis is quickly becoming a dynamic therapeutic area. The newest entrant into the psoriasis market, Novartis’ Cosentyx, was approved in January 2015. By targeting IL-7, Cosentyx’s unique mechanism of action touts sustained efficacy compared to other agents in the market. Otezla, an oral psoriatic drug was also approved for psoriasis in September 2014.  It has the advantages of an oral route of administration but has not fared well with payers so far.

Despite newer agents and a strong pipeline, Enbrel and Humira continue to dominate as market leaders. Rheumatoid arthritis remains the primary driver of contracting decisions. Therefore, payers continue to choose preferred agents based upon its market share in rheumatoid arthritis rather than psoriasis. Both drugs can be used for Rheumatoid arthritis and psoriasis.

Analysis, conducted by the Policy and Access Tracking Tool team at Zitter Health Insights, has shown that the majority of payers still prefer the use of traditional anti-TNF agents, Enbrel and Humira. While some payers have begun to disadvantage Enbrel, the majority of all Commercial covered lives fall under plans that allow Enbrel and Humira to be approved without a biologic step therapy requirement.

Both Cosentyx and Otezla face entry barriers with more than 50% of covered lives being required to fail at least two biologics prior to approval; Stelara has also seen an increase in plans and lives subject to these requirements.

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Research has shown that the approvals of Cosentyx and Otezla have enabled increased management aggressiveness of this therapeutic category. Payer management of the psoriasis category is expected to continue to grow as payers push to control costs associated with the growing patient population and upcoming pipeline agent approvals.

Will these trends continue in the near future? Whatever changes and trends in the market that occur, Zitter Health Insights plan on tracking the evolution.

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