Health

Optum: 4 drugs in the pipeline payers should be watching

OptumRx has released its quarterly look at the drug pipeline, and two of the therapies highlighted in the report target fairly common conditions.

Finerenone, or the brand name Kerendia, was approved by the Food and Drug Administration on July 9. The drug treats chronic kidney disease and type 2 diabetes. Some 26.8 million Americans have been diagnosed with diabetes, and one in three eventually develop some kind of kidney disease.

Bill Dreitlein, senior director of pipeline and drug surveillance at OptumRx, told Fierce Healthcare that the drug will be entering a market where many patients are already treated by low-cost therapies.

“With the entrance of this drug, some patients are going to shift from a low-cost treatment to a higher-cost treatment,” he said.

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He added that chronic kidney disease has been a high-activity area, a trend that extends to drug development, so expect to see that continue.

“Chronic kidney disease, I think, is an area where there’s going to be more light shown on it over the course of the next year or so,” he said.

The other drugs highlighted in the report are:

  • Atogepant, which is pending a brand name, a drug that treats episodic and chronic migraines.
  • Odevixibat, or the brand name Bylvay, which treats progressive familial intrahepatic cholestasis, a liver disease.
  • Maralixibat, which also has yet to set a brand name, treats Alagille Syndrome, a rare genetic disease of the liver.

Atogepant presents a similar consideration to Kerendia for payers, Dreitlein said, in that it could encourage people with a fairly common condition to switch to a higher-cost therapy. He said weighing those coverage decisions is a “constant tension” that pharmacy benefit managers navigate in ensuring people can access the drugs they need while managing costs.

RELATED: Optum: Why COVID-19 could significantly change the drug development pipeline

Dreitlein said Optum’s team tracks clinical trials data that measures who the drug has demonstrated efficacy for. It also brings its coverages plans to a pharmacy and therapeutics committee that includes providers who can weigh in on how those plans will impact their ability to care for patients.

The goal is “to make sure that the policy we come up with is reasonable for most people most of the time,” he said.

The report also notes that Bylvay and maralixibat, if approved, would enter the same liver disease market and could compete against one another for share. Both drugs are also currently being evaluated for other indications within the space, which could drive further competition.

Drugs gaining approval for multiple indications is a key trend for payers to watch, according to the report. Dreitlein called it “indication creep.”

“Because there’s nothing else available, you can see the footprint of that drug grow as it’s used initially off-label and then on-label for these other conditions,” he said.

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