Market access restrictions for high efficacy Multiple Sclerosis therapies may be hindering their ability to optimally treat their clinically complex, relapsing patients, according to a new report from Spherix Global Insights
Advanced practice providers (APPs), including nurse practitioners and physician assistants, play an important role as providers of care for patients with multiple sclerosis (MS). In a new report by Spherix Global Insights, 53 APPs were surveyed about their use of disease modifying therapies (DMTs) and their results were compared to a parallel report of 98 US neurologists. Overall, the APPs report significantly greater clinical experience and comfort with monoclonal antibody (mAb) DMTs, and significantly less familiarity and use of the interferons, compared to the surveyed neurologists. APPs, who spend most of their time seeing patients and are often tasked with oversight of onsite infusion capabilities, tend to manage clinically complex, relapsing patients who may be appropriate candidates for a DMT switch. Consequently, APPs report not only significantly higher shares of Biogen’s Tysabri and Sanofi Genzyme’s Lemtrada, but also appear to be early adopters of Roche’s Ocrevus with a share that is more than double that of neurologists. A significantly higher percent of APPs are active users or Lemtrada compared to neurologists. This could be because APPs are more likely to have the time to devote to the long-term monitoring required with Lemtrada, whereas neurologists, especially those with limited office support, rely more on the injectable, such as EMD Serono’s Rebif, and oral DMTs, including Biogen’s Tecfidera. In addition, APPs report being less hindered by PML and risk-benefit profile concerns associated with the mAb DMTs compared to neurologists.
APPs perceive that slightly more of their MS patients are receiving suboptimal treatment due to inadequate/inferior insurance coverage compared to neurologists, potentially being reflective of their higher mAb class share which is associated with greater payer restrictions. Indeed, instead of safety, barriers to using mAb DMTs are more related to reimbursement/payer restrictions and patient reluctance. For Ocrevus specifically, more APP prescribers report extreme difficulty obtaining payer approval for secondary progressive MS and primary progressive MS patients compared to neurologist prescribers. Similarly, more APPs rate Ocrevus-related support and insurance/reimbursement attributes as being less than expected at this point post-launch compared to neurologists — representing a potential strain on uptake with their greater involvement in pharmacy claim processing.
More APPs report a sales representative visit within the past month compared to neurologists across multiple brands, including significantly higher percentage for Lemtrada and slightly higher for Tysabri, Biogen’s Aubagio, and Teva’s Copaxone. Because of their higher reported Tysabri and Lemtrada shares and emphasis on strong patient support programs, the APPs may be sought out by the Biogen and Sanofi Genzyme representatives to discuss patient care, follow up, and reimbursement support. Indeed, a local reimbursement landscape message is recalled significantly more often during recent Ocrevus details compared to neurologists. With the broad prescriber bases and shares, continued APP outreach regarding mAb DMT-related support services will be key to ensure continued uptake among this influential HCP group.
RealTime Dynamix™: Advanced Practice Providers in Multiple Sclerosis (US) is an independent report series published on an annual basis. The series provides analysis and tracking of key performance metrics, focusing on brand gains and losses, industry contact rates, familiarity and adoption rates of recently launched products and awareness of products in development. In addition, qualitative interviews were conducted with a subset of APP respondents. Where appropriate, comparisons were made to neurologist data collected in parallel for the RealTime Dynamix: Multiple Sclerosis (US) Q3 2017 report.
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About Spherix Global Insights
Spherix Global Insights is an independent business intelligence and market research company, specializing in renal, autoimmune, neurologic and rare disease markets. Our aim is to apply our commercial experience and unique relationships within core specialty markets to translate data into insight, enabling our clients to make smarter business decisions.
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SOURCE Spherix Global Insights