The Pricing and Reimbursement Environment for Immune Disease Therapies
Decision Resources
June 25, 2009 45 Pages - SKU: DECR2303149
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Introduction
Drug therapies for immune disorders span an enormous price range-from a few cents per day to tens of thousands
of dollars per year. Not surprisingly, payers impose restrictions on the use of the most expensive agents,
especially biologics. These restrictions will inevitably intensify in the coming years, as the prevalence of immune
disorders increases.
Get the Answers You Need to Shape Your Strategy
- Health technology assessment will increasingly infl uence coverage of immune disease therapies in most
markets in the future. What changes are likely in Europe? How will government support for comparative
effectiveness research affect the U.S. market?
- The United States has the highest overall prices of any of the major pharmaceutical markets, but prices for immune
and infl ammatory drugs vary widely from country to country. How do European and Japanese prices
for best-selling immune disease therapies compare with prices in the United States? Which drugs in this
therapeutic area are more expensive in Europe and Japan than in the United States?
- Health insurers in the United States generally offer relatively generous coverage of immune disease therapies
but are seeking to control their costs. What are the main sources of funding of drug therapy for immune
disorders in the United States? What coverage restrictions do payers impose on best-selling immune
disease therapies?
- European reimbursement authorities limit access to high-priced immune disease therapies. Which drugs are
key targets for reimbursement restrictions in Europe? What role do health technology assessment bodies
play in regulating the use of drugs in this therapeutic area?
09H406-Abstract.indd 1 6/23/2009 11:26:31 AM
Decision Resources 6-2
- The Japanese government has not employed the types of cost-containment measures used in the
United States and Europe. How does the Japanese healthcare system control spending on immune
disease therapies? What restrictions are imposed on off-label prescribing in Japan?
Scope
- International price comparisons for immune disease therapies: tumor necrosis factor-alpha inhibitors;
asthma therapies; immunosuppressants and cytotoxic agents; nonsteroidal anti-infl ammatory
drugs (NSAIDs); allergy remedies.
- Reimbursement environment in the United States, France, Germany, Italy, Spain, the United
Kingdom, and Japan: general environment; musculoskeletal disorders; respiratory disorders; gastrointestinal
disorders; other disorders.
- Outlook and implications for the pharmaceutical industry: impact of health reform in the United
States; cost-containment trends; prospects for biosimilars; increasing use of health technology assessment;
conditional reimbursement agreements.
Mentioned in This Spectrum Report
Drugs and Companies
Adalimumab (Abbott/Eisai's Humira)
Budesonide (AstraZeneca's Rhinocort/Pulmicort)
Celecoxib (Pfi zer's Celebrex; Astellas Pharma's Celecox)
Cetirizine (Pfi zer/UCB's Zyrtec)
Desloratadine (Schering-Plough's Clarinex)
Diclofenac (Novartis/Endo Pharmaceuticals' Voltaren)
Etanercept (Amgen/Wyeth/Takeda's Enbrel)
Fexofenadine (Sanofi -Aventis's Allegra)
Formoterol (Novartis/Schering-Plough's Foradil)
Infl iximab (Johnson & Johnson/Schering-Plough/Mitsubishi Tanabe Pharma's Remicade)
Loratadine (Schering-Plough/Shionogi's Claritin)
Meloxicam (Boehringer Ingelheim's Mobic)
Mometasone (Schering-Plough's Nasonex)
Montelukast (Merck & Co.'s Singulair)
Mycophenolate mofetil (Roche's CellCept)
Omalizumab (Genentech/Novartis's Xolair)
Salmeterol (GlaxoSmithKline's Serevent)
Salmeterol/fl uticasone (GlaxoSmithKline's Advair/Seretide; GlaxoSmithKline/Mitsubishi Tanabe Pharma's Adoair)
Tacrolimus (Astellas Pharma's Prograf)
Tiotropium (Boehringer Ingelheim/Pfi zer's Spiriva)
Please note, the PDF e-mail from publisher version of this report is for a global site license.
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- Executive Summary
- Strategic Considerations
- Stakeholder Implications
- Introduction
- International Price Comparisons for Immune Disease Therapies
- Overview
- Tumor Necrosis Factor-Alpha Inhibitors
- Asthma Therapies
- Immunosuppressants and Cytotoxic Agents
- Nonsteroidal Anti-Infl ammatory Drugs (NSAIDs)
- Allergy Remedies
- Reimbursement Environment
- United States
- General Environment
- Cost-Containment Measures
- Musculoskeletal Disorders
- Respiratory Disorders
- Gastrointestinal Disorders
- Other Disorders
- France
- General Environment
- Musculoskeletal Disorders
- Respiratory Disorders
- Gastrointestinal Disorders
- Other Disorders
- Germany
- General Environment
- Musculoskeletal Disorders
- Respiratory Disorders
- Gastrointestinal Disorders
- Other Disorders
- Italy
- General Environment
- Musculoskeletal Disorders
- Respiratory Disorders
- Gastrointestinal Disorders
- Other Disorders
- Spain
- General Environment
- Musculoskeletal Disorders
- Respiratory Disorders
- Gastrointestinal Disorders
- Other Disorders
- United Kingdom
- General Environment
- Musculoskeletal Disorders
- Respiratory Disorders
- Gastrointestinal Disorders
- Other Disorders
- Japan
- General Environment
- Musculoskeletal Disorders
- Respiratory Disorders
- Gastrointestinal Disorders
- Other Disorders
- Outlook and Implications for the Pharmaceutical Industry
Tables
1. Leading Immune Disease Therapies
2. Ex-Manufacturer Prices of Select Immune Disease Therapies in Europe and Japan as a Percentage of U.S. Prices, 2008
3. Coverage of Select Immune Disease Therapies by Leading U.S. Private Insurers and Pharmacy Benefi t Management Companies
4. Assessment of Select Immune Disease Therapies by France’s Transparency Commission
Figures
1. Average Ex-Manufacturer Prices of Immune Disease Therapies as a Percentage of U.S. Prices, 2008
2. Average Ex-Manufacturer Prices of Tumor Necrosis Factor-Alpha Inhibitors as a Percentage of U.S. Prices, 2008
3. Average Ex-Manufacturer Prices of Asthma Therapies as a Percentage of U.S. Prices, 2008
4. Average Ex-Manufacturer Prices of Immunosuppressants and Cytotoxic Agents as a Percentage of U.S. Prices, 2008
5. Average Ex-Manufacturer Prices of NSAIDs as a Percentage of U.S. Prices, 2008
6. Average Ex-Manufacturer Prices of Allergy Remedies as a Percentage of U.S. Prices, 2008
7. Health Insurance Coverage of the U.S. Population, 1997-2007
8. U.S. Residents’ Sources of Prescription Drug Benefi ts, July 2008
9. Sources of Healthcare Funding for U.S. Residents by Immune Disease, 2008
10. Cost-Containment Measures Used by U.S. Employers to Control Spending on Asthma Therapies, 2007-2008
11. Drugs Prescribed to Italian Psoriasis Patients at the Time of Their Enrollment in Progetto Psocare
12. Number of Drugs Taken by Italian Psoriasis Patients Enrolled in Progetto Psocare Prior to Their Current Therapy
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