New Report Finds All Reviewed Psoriasis Therapies a Good Value Calls for Abolishing or Limiting Step Therapy
Dec 06, 2016, 05:42 ET
PORTLAND, Ore., Dec. 6, 2016 The National Psoriasis Foundation (NPF), a non-profit organization whose mission is to drive efforts to cure psoriatic disease and improve the lives of those affected, applauds the new Institute for Clinical and Economic Review (ICER) report indicating that all currently approved advanced therapies for psoriasis offer a good value.
The report and final recommendations cap a year-long process in which the organization examined the value of psoriasis treatments. With drug pricing continuing to receive much attention, the work of ICER has taken on more importance than ever, particularly with evidence suggesting the insurers use such recommendations to shape policy.
The therapies reviewed were Humira (adalimumab), Enbrel (etanercept), Remicade (infliximab), Cosentyx (secukinumab), Taltz (ixekizumab), brodalumab (not yet FDA approved), Stelara (ustekinumab), as well as Otezla (apremilast) - which is a small molecule drug and not a biologic.
In addition to concluding that all of the reviewed therapies offer a good value, ICER also determined that step therapy – which impedes patient access to certain treatments – is inappropriate for people diagnosed with psoriasis and should be limited or abolished.
"The National Psoriasis Foundation is very pleased with the final recommendations and in the significant role we have played to provide input which informed the final report. The final report accurately reflects the challenges of living with psoriatic disease and it recommends insurers expand the tools physicians have available to care for patients managing this complex disease over a lifetime," said NPF CEO Randy Beranek.
Throughout the year-long review, NPF highlighted the complexity of psoriasis, challenges in disease management, and pervasive impacts of the disease. These points were reiterated by NPF experts and staff on November 18, 2016, when the New England Comparative Effectiveness Public Advisory Council (CEPAC) met to deliberate and vote on evidence presented in a report on treatments for psoriasis. Following that meeting, an ICER report analyzed eight advanced medications used to treat moderate to severe plaque psoriasis.
NPF is particularly pleased by ICER's willingness to engage the patient community and clinical experts, as demonstrated by the sizeable shift from the findings in the draft report, issued in late September, to the final report issued in early December.
"Given that insurers and the government are increasingly looking to ICER and other value framework modelers to advise them on coverage decisions, it is critical that the viewpoint of patients and patient advocacy groups are included in the final analysis of any treatment options," said Randy Beranek, National Psoriasis Foundation president and CEO. "We appreciate that ICER's final report accurately captures the preferences of patients and real world experiences of clinicians."
ICER's final report includes the following recommendations for payers:
- Consider limiting or abolishing "step therapy" approaches to coverage.
- If step therapy will be used
- Allow individuals switching insurers to bypass step therapy if they are already on an effective treatment.
- Remove requirements for patients to have higher out-of-pocket expenses for "later step" treatments.
- If step therapy will be used
- Co-payment and/or co-insurance for therapies should be based on prices net of discounts and rebates instead of list price.
"This report and its policy recommendations demonstrate that insurance practices that limit access to psoriasis therapies are short-sighted," said Dr. Abby Van Voorhees, chair of the NPF Medical Board, and professor and chair of dermatology at Eastern Virginia Medical School. "ICER's findings that all the reviewed therapies have good value, and policy recommendations that payers should strongly consider eliminating most step therapy requirements is a strong step toward a more patient-centric approach to care," said Van Voorhees. "I'm hopeful this means I'll have the ability to treat my patients and support them on their journey with the therapy most appropriate for them."
For more information on this topic, visit www.psoriasis.org/value-frameworks.
National Psoriasis Foundation (NPF) is the world's largest nonprofit dedicated to people with psoriasis and psoriatic arthritis. Our priority is to provide the services people need to take control of their condition, while increasing research to find a cure. In addition to serving millions of people annually through our health education and advocacy initiatives, NPF has funded more than $14 million in research grants and fellowships. Learn more about the Psoriasis Foundation at www.psoriasis.org or call 800-723-9166. Follow us on Facebook and Twitter.
SOURCE National Psoriasis Foundation