OBJECTIVES: The objective was to outline pricing and access optimization factors for innovative products competing within a crowded RA market

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. Hypotheses from these findings were developed and the assumptions were tested with in-market experts, along with contracting strategies to mitigate the current competitive RA landscape.

RESULTS: Currently, contracting varies by plan size, formulary design, and portfolio discounts. Small to mid-sized plans focus on cost-containment, restricting access to multiple agents in various MOAs. Large PBMs choose to 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 at a greater frequency (6-9 months) to assess potential net savings from lower cost options. Plan contracting style will likely shift towards an indication-based approach rather than portfolio-based approach across the autoimmune space. Payers will move to restrictive management strategies with a no-access tier or exclusion list for agents lacking competitive advantages and market share.

CONCLUSIONS: Biosimilars and generics will likely be the preferred 1^st line agents, leaving branded products to compete for the preferred 2^nd line as well as having to avoid exclusion. Novel therapies entering the RA market will be required to demonstrate clear advantages in efficacy and durability as well as significant cost incentives within contract negotiations for preferred 2^nd or 3^rd line consideration. Agents failing to meet these standards may face risk of no access.