Survey of American Dermatologists and Payers Finds Abbvie's Humira is the Clear Leader in Psoriasis Treatment and that the Availability of Biosimilars and an Increasing Number of IL-17 Inhibitors Will Shape Treatment and Reimbursement Decisions in Coming Years

BURLINGTON, Mass., Sept. 21, 2015 /PRNewswire/ -- Decision Resources Group finds that Abbvie's Humira (adalimumab) has established a solid lead over Amgen/Pfizer's Enbrel (etanercept) as the biologic most prescribed for moderate to severe psoriasis, despite Enbrel having a more favorable reimbursement environment. Our survey suggests that both Humira and Enbrel will experience erosion as payers expect to make biosimilar adalimumab available at preferential formulary positions, and institute policies to encourage their use. Meanwhile, as Janssen's Stelara (ustekinumab) has had some success in gaining use as a first-line biologic, payers continue to restrict its use, resulting in Stelara's patient share continuing to rely on patients who have failed one or more TNF-alpha inhibitors, such as Enbrel or Humira. Furthermore, Stelara's share of this market is challenged by the recently and soon to be launched IL-17 inhibitors: Novartis' Cosentyx (secukinumab), Eli Lilly's ixekizumab, and Valeant/AstraZeneca's brodalumab. IL-17 inhibitors are viewed favorably by physicians and payers expect reimbursement conditions to improve as experience with Cosentyx grows over time and additional agents become available. These findings, along with physician and payer views on the two new oral therapies: the recently launched Otezla (Celgene's apremelast), and Pfizer's emerging therapy Xeljanz (tofacitinib), shed light on the many changes that will occur in psoriasis treatment over the next three years.

Other key findings from the US Physicians and Payers Forum report entitled Moderate to Severe Psoriasis: Physician and Payer Receptivity to Novel Oral and Biologic Agents vs. Biosimilars

• The potential for brodalumab to be approved with a warning label for suicidal ideation will strongly impact acceptance of the drug by both physicians and payers, and will also impact perception of the other IL-17 inhibitors: Cosentyx and ixekizumab.
• Physicians are using the newest oral psoriasis medication, Otezla, as a replacement for older oral systemic agents or as a step between older medications and biologics. However, high out of pocket costs and reimbursement restrictions limit physicians' ability to prescribe the drug.
• If it is approved for psoriasis, Xeljanz is likely to see usage patterns similar to Otezla. However, perceptions of a poor risk-benefit ratio and expected high price by both physicians and payers will constrain prescribing, and physicians' willingness to prescribe the agent will depend strongly on its tier positioning.
• Overall, there is low awareness of the development of IL-23 inhibitors by both payers and physicians.

Comments from Decision Resources Group Analyst Brian Nasipak:

• "Physicians report that they are already prescribing Humira to more patients than they are Enbrel, even though both physicians and payers report that Enbrel has the better formulary position. Our survey finds that physicians are willing to prescribe biosimilar adalimumab, and if payers make it easier to obtain reimbursement for biosimilar adalimumab before Enbrel, we may see erosion not just of Humira, but Enbrel as well."
• "New biologic therapies are competing with Stelara for those patients who have failed TNF-alpha inhibitors, and many physicians indicate that an established safety profile is important to them when deciding to prescribe a new therapy. So it's not surprising that if brodalumab is approved with a warning label both physicians and payers will be influenced, most strongly in regard to brodalumab, but to a lesser extent other IL-17 inhibitors as well."

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