1. Health Strategies Group
1/12/2019
Health Strategies Group
Author/Artist
Key Finding #4 Access Risks for Brands Will Continue to Rise as Market Competition and Resulting Stakeholder Management Grow
Projected Access Impact by 2020
Evolving Market Dynamics Impacting MS Drug Access
Availability of multisource generics for high-volume brands, posing substantial competition to reference brands
Given sizable pricing advantages upon multisource availability of glatiramer acetate (Copaxone) and fingolimod (Gilenya), stakeholders will take advantage of competition to bring down costs.
High
Growing adoption of increasingly aggressive management, including leveraging of member
cost-sharing differentials, step therapy, PAs,
PDLs, and broader coverage exclusions
While some flexibility will remain in treatment choice for hard-to-treat patients, plans will leverage brand competition and generics to drive use to preferred drugs; clear brand value propositions will be critical.
Moderate-High
Continued acceptance of large contract incentives and competitive rates from companies producing MS drugs, as well as potential emergence of
risk-based contracts to differentiate drugs
Contracts for preferred brands within competitive classes (e.g., interferons) will limit access for competitors; growing competition will create need for novel contracting strategies.
Moderate-High
Entrance of additional branded MS drugs, increasing competition within mechanisms of action and/or modes of administration
Brands that fail to demonstrate substantial long-term efficacy in real-world settings will likely face access barriers relative to more efficacious brands.
Moderate-High
Development and implementation of treatment guidelines and protocols across stakeholders and by specific MS indications
The approval of new drugs with never-before-available indications (e.g., primary progressive MS, secondary progressive MS) will begin to drive use of guidelines to steer drug use by diagnosis.
Moderate
Abbreviations: PA, prior authorization, PDL, preferred drug list.
Source: Health Strategies Group, Brand Access Marketplace Dynamics, June 2018.