Neurologists Report Increasing Payer Pressure for Disease-Modifying Therapies, Resulting in Suboptimal Treatment for Some Patients with Multiple Sclerosis
August 1, 2016 – Cambridge, MA- In the Q2 update of RealTime Dynamix™: Multiple Sclerosis, roughly one-quarter of the respondents reported increased payer restrictions for Teva’s Copaxone while restrictions have eased somewhat for Sandoz’s Glatopa, Novartis’ Extavia and Biogen’s Tecfidera. While half of the neurologists agreed that payers are becoming more aggressive with MS patient management, only one-quarter stated that payer policies are strongly influencing their use of specific DMT brands.
While increased use of oral DMTs, particularly as first-line options, continues to be cited as one of the major practice pattern shifts, another noteworthy shift emerged this quarter related to increased patient monitoring. More wide-spread use of the JC virus assay and associated titers is occurring for patients considered candidates for Biogen’s Tysabri and Tecfidera and Novartis’ Gilenya. In addition, more attention is being placed on monitoring lymphocyte counts for patients on Tecfidera. While this does not appear to be translating into diminishing share for these brands, a heightened awareness about potential safety issues could temper enthusiasm for expanded use. In fact, share projections for Tecfidera and Tysabri are flat while neurologists anticipate a significant increase for Gilenya in the next three months.
Only 14% of the survey respondents had registered in the Zinbryta REMS program at the time of this survey, but roughly half predict that they will have some patients on the new DMT within the next six months. The outlook is rosier for Roche’s Ocrevus which could be available by year end. Many neurologists anticipate using Ocrevus as soon as it becomes available with 40% of the respondents anticipating a decrease in their use of Tysabri once Ocrevus hits the market.
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