Creative contracting initiatives key for pharma as competition in RA market increases

The rheumatoid arthritis (RA) payer market has experienced increasingly competitive forces, prompting RA drug manufacturers to experiment with new contracting initiatives to gain preferred formulary placement.

According to the Managed Care Message Monitor (MCMM) Rheumatoid Arthritis report (The Zitter Group), based on surveys of managed care payer organizations (n=79), representing 192 plans from February through July, 2011, the messages captured for RA products are focused more on contracting and rebates since fourth quarter 2010. In addition, contracting and cost discussions account for an increasing percentage of RA discussion at the expense of product safety and efficacy discussions.

According to the MCMM, RA is the fifth payer management priority discussed (6%), tied with multiple sclerosis (MS), which is also a therapeutic category with multiple high-cost agents. Payers identified the top RA drugs with the highest management priority are etanercept (#1); infliximab (#2); adalimumab (#3); rituximab (#6); abatacept (#24); and certolizumab pegol (#27).

The top MS agents are fingolimod (#4) and glatiramer (#5), according to the report. Although most RA specialty drug manufacturers are focused on contracting and differentiating their products in the current competitive market, Roche/Genentech and Pfizer are geared more toward educational strategies, and Pfizer is utilizing more medical science liaisons for this.

When unaided messages were discussed, formulary management topics and messages about infliximab were perceived by payers as more credible than other product messages, according to the report. Abbott's overall lead product adalimumab, its primary focus, is aimed at gaining preferred formulary status. Discussions of value-added and disease management programs, competitive messages, copayment issues, and rebating opportunities are reportedly perceived as positive. Etanercept messages center around its market leader status, including its distinct mechanism, predictable dosing, higher rebates for dosing limits, preferred formulary status, and contracting versus adalimumab and infliximab. For abatacept, the main focus is on the new subcutaneous (SC) formulation. Infliximab messages relate to contracting and management, while golimumab messages highlight product convenience (eg, auto-injector, SC, and once-monthly dosing). In the contracting arena, biopharma leader UCB touts rapid effectiveness for its certolizumab pegol, which is appealing to payers because "if a patient has no clinical response within 12 weeks, UCB will reimburse the plan for the cost of therapy."