OBJECTIVES: The objective was to outline pricing and access factors to consider for a new product entering RA.

METHODS: Secondary research was conducted to assess the current RA landscape (HTA ratings, ICER evaluations of currently available therapies). The number of products in the pipeline and estimated time of launch were compiled to outline the expected environment over the next decade. Hypothesis from these findings were developed and the assumptions were tested with in market experts. The respondents additionally outlined contracting strategies within the current landscape.

RESULTS: Currently, contracting varies by size of plan, type of formulary design, and portfolio level discounts. Small to mid-sized plans focus on cost-containment, maximizing on portfolio discounts/rebates by restricting access to multiple agents in various MOAs. Larger plans, benefiting from greater number of lives covered, maximize on rebates by preferring 1 or 2 agents across multiple classes. As biosimilars and generics enter the space, payers will re-evaluate portfolio discounts with potential net savings from lower cost options. Plan contracting style will likely shift towards an indication-based approach rather than portfolio approach across the autoimmune space, and will carve out a separate “preferred class” after failure to biosimilars and generics.

CONCLUSIONS: Biosimilars and generics will likely be the preferred 1^st line agents across most plans. As a result, payers are expected to enforce 1 or 2 step-edits before allowing access to brand products, carving out a preferred 2^nd or 3^rd line for the latter.