For Migraine Treatment, Surveyed Physicians and MCO Pharmacy Directors Indicate that Allergan's Botox Will Experience Greater Use and Improved Formulary Coverage in the Next Year

New Non-Oral Triptans and Non-Triptan Products Will Provide Acute Treatment Alternatives for Oral Triptan Non-Responders, According to a New Report from Decision Resources

May 08, 2013, 09:00 ET from Decision Resources

BURLINGTON, Mass., May 8, 2013 /PRNewswire/ -- Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that surveyed neurologists and primary care physicians (PCPs) expect to more than double their use of Allergan's prophylactic migraine treatment Botox in the next year, presumably owing to its perceived efficacy in both episodic and chronic migraine and its favorable safety and tolerability profile. Nevertheless, patient share for Botox will remain modest, because the drug is typically relegated to later lines of therapy. In addition, a substantial percentage of surveyed physicians do not prescribe Botox, citing difficulties with in-office administration, insufficient patient demand and high cost to patients.

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The U.S. Physician & Payer Forum report entitled Evolving U.S. Market Access and Clinical Practice in the Era of Generic Triptans, Innovative Reformulations, and Botox finds that the increased use of Botox will also be aided by anticipated improvements in its formulary coverage. According to surveyed managed care organization (MCO) pharmacy directors, Botox currently secures relatively favorable coverage on most of their commercial plans, and many directors expect to improve the tier placement of Botox in the next year, although the total number of plans covering Botox is unlikely to increase significantly.

"Approximately three-quarters of surveyed MCO pharmacy directors' largest commercial plans reimburse Botox, many of whom cover the drug for any form of headache at the physicians' discretion, rather than exclusively for chronic migraine," said Decision Resources Analyst Anne-Elise Tobin, Ph.D. "One-third of those who reimburse Botox as a pharmacy benefit expect to place Botox on a more favorable tier in their largest commercial plan in the coming year. These data suggest that Botox's branded price, in an otherwise generic market, is not an unsurpassable obstacle to reimbursement in most plans."

The report also finds that while more than half of surveyed physicians' acute-drug treated migraine patients receive triptans, they consider one-fifth of their episodic migraine patients and one-quarter of their chronic migraine patients to be triptan non-responders. Most surveyed physicians anticipate prescribing emerging non-triptan products—Allergan's Levadex (orally inhaled dihydroergotamine) and CoLucid's lasmiditan—as well as emerging non-oral triptan reformulations—NuPathe's Zecuity (sumatriptan transdermal patch) and OptiNose's intranasal sumatriptan powder—to patients who do not respond to oral triptans, presumably expecting improved bioavailability from non-oral formulations compared with oral triptans. These data underscore the need for alternative treatments in this underserved patient segment. Similarly, most surveyed pharmacy directors indicate a willingness to reimburse such therapies but expect to place the agents on higher tiers on their commercial formularies and impose cost controls, demonstrating the continued cost-sensitivity in a market replete with generic options.

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