Limited Off-Label Use and Competition for Preferred Status Have Led to the Need for Expanded Labeling of Immune Biologics To Sustain Steady Market Growth

NASHVILLE, Tenn. and GLEN ROCK, N.J., Sept. 27 /PRNewswire/ -- HealthLeaders-InterStudy and Fingertip Formulary find that the market growth of immune biologics will come from the expansion of indications for immune biologics in response to limited off-label use and competition for preferred status. A majority of U.S. health plans will not reimburse for off-label use of immune biologics. In addition, one-half of surveyed health plans report granting preferred status to a single biologic for all immune conditions; and by the year 2015, 75 percent of surveyed plans expect to practice this measure. As a result, drug manufacturers who have offered expanded indications and routes of administration are positioning their products to compete more effectively in this evolving environment.

The report entitled Formulary Advantages in Immune Biologics: Brand Maneuvering in a Market Increasingly Constrained by Limited Payer Reimbursement also finds that health plans are scrambling to limit their costs related to reimbursing immune biologics, which will be the biggest market constraint in the near term. Greater than one-third of surveyed plans employ strategies to increase patient cost-sharing for immune biologics and that number will more than double in the next five years.

"Because of the enormous cost burden of immune biologics, payers are utilizing every available strategy to limit patient access to immune biologics, to reduce physician reimbursement for dispensing and administering these agents and to strengthen their negotiations with marketers," said Analyst Leigh Compton, M.D., Ph.D., author of the report. "Moving immune biologics onto specialty tiers and requiring patients to pay percentage-based coinsurance and higher copays will lessen the growing cost burden for payers. Understanding the criteria that health plans are using to evaluate reimbursement will be essential in order for companies to optimally maneuver their brands in a market constrained by payers' desire to limit reimbursement."

The new Formulary Forum report is based on a survey of 50 U.S. pharmacy directors who control formularies at national, regional and state-level managed care organizations, as well as historical formulary data from Fingertip Formulary.

Webinar

Purchasers of the report Formulary Advantages in Immune Biologics: Brand Maneuvering in a Market Increasingly Constrained by Limited Payer Reimbursement are welcome to attend the webinar entitled Getting Ahead of the Reimbursement Curve: How Will Your Immune Biologic Brand Fare? This webinar will be held on Tuesday, October 19, 2010 at 1:00 p.m. U.S. Eastern Time. For more information, please contact Erin O'Leary at 781-993-2641 or by email at [email protected].

About Fingertip Formulary

Fingertip Formulary (www.FingertipFormulary.com), the leading provider of access to and insight into formulary data in the United States, offers comprehensive formulary data covering commercial, Medicaid, Medicare and PBM plans, among others. Fingertip Formulary is a Decision Resources, Inc. company.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Both HealthLeaders-InterStudy and Fingertip Formulary are Decision Resources, Inc. companies. Please visit Decision Resources, Inc. at www.DecisionResourcesInc.com.

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SOURCE HealthLeaders-InterStudy