The Pricing and Reimbursement Environment for Immune Disease Therapies : Market Research Report

The Pricing and Reimbursement Environment for Immune Disease Therapies

Published: Jun. 25, 2009 - 45 Pages

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; France; Germany; Italy; Spain; United Kingdom; Japan; 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

Abstract

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)

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The Pricing and Reimbursement Environment for Immune Disease Therapies

Table of Contents

Abstract