Decision Resources has a new "forward looking" (i.e., speculative) survey out, based on a series of "what ifs". The most important one of all (and perhaps the least likely to actual transpire) is "What if Vertex's Telaprevir® and New Merck's Boceprevir® are both approved by FDA on the same day?" [To be clear, despite the headline of this breathless MarketWatch story, neither is FDA-approved.]
The next assumption is that both are labeled for all forms of combination therapies. Finally, the last assumption is that they are reimbursed, and priced, comparably.
I think it highly likely that Telaprevir will reach the United States market ahead of Boceprevir -- and it is not seriously disputed that Teleprevir has thus far shown the superior efficacy data. As any exerienced pharma denizen will tell you, the first to market in the U.S. will enjoy a vast, and multi-year advantage -- over the latter arrivals, absent a terrific increase in efficacy in favor of the late arrival.
It truly would be a "moon-shot" -- if Boceprevir were to turn out to post better final data than Telaprevir. In any event -- here is the crux of this "what if" survey -- for what it may be worth:
. . . .The new Physician & Payer Forum report entitled Hepatitis C: Reimbursement and Uptake of Novel Antivirals Among Payers and Prescribers finds that surveyed physicians expect to treat 71 percent of treatment-naive and 78 percent of nonresponder patients with telaprevir/peg-IFN/ribavirin vs. 19 percent of treatment-naive and nonresponders with boceprevir/peg-IFN/ribavirin. Similar to clinicians, managed care organizations' (MCO) pharmacy directors are open to reimbursing telaprevir and boceprevir. . . ."Only 10 percent of the pharmacy directors we surveyed do not expect to add telaprevir or boceprevir to their drug formularies," said Decision Resources Analyst Alexandra Makarova, M.D. Ph.D. "The remaining surveyed pharmacy directors are split regarding the choice of the protease inhibitor for addition to their formularies. Twenty-five percent expect to add both telaprevir and boceprevir, while 15 percent will add only telaprevir and 5 percent will add only boceprevir. Forty percent of pharmacy directors will make their choice based on the relative cost of each agent. . . ."
Like I say -- take all of this with a truckload of salt, as it only reflects what physicians and payors might do, if all of the candiates receive FDA approval at the same time -- and that is almost certain not to be the case. And so, the 71 to 19 advantage for Teleprevir is likely to be even wider than the admittedly-very-limited survey predicts.
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