Managed Care Outlook

As sales for autoimmune disease drugs go up, donut hole relief is on the way


The worldwide market for medications for autoimmune disorders is expected to grow from $61.5 billion in 2015 to $74.2 billion in 2022, according to GBI Research, a health care information and data company headquartered in London. The company expects Eli Lilly’s biologics, baricitinib and ixekizumab (Taltz), to be particularly strong sellers. GBI also predicted in a November 2015 report that APB-501—the provisional name for Amgen’s biosimilar to AbbVie’s Humira (adalimumab)—will generate annual revenues of almost $1 billion by 2022.

Projected worldwide sales of autoimmune disease medications*

Market size ($bn)

*GBI’s forecast includes biologics, other medications, and drugs in the development pipeline. Medications for inflammatory bowel disease (Crohn’s disease and ulcerative colitis), multiple sclerosis, and type 1 diabetes are not included in this forecast.

Source: GBI Research, “Global Immunology Market to 2022,” November 2015

These rosy predictions for sales may take on a different hue from the patient perspective. A study published last year in Arthritis & Rheumatology looked at 2,737 formularies for Medicare Part D plans in 50 states and Washington, D.C., from 2013. The researchers found that nearly all plans required coinsurance and that translated into an average out-of-pocket expense of about $2,700.

Changes to the coverage gap in the Part D plans—often referred to as the donut hole—might help ease the out-of-pocket burden. The ACA gradually lowers the patient share of drug expenses during the donut hole phase. This year, seniors are paying 45% of the price of brand-name drugs while they are in the donut hole and 65% of generics, compared with 47.5% and 79%, respectively, in 2013. By 2020, the patient share for both brand-name and generic drugs is scheduled to be 25%.

Filling in the donut hole
Year Patient share brand-name drugs in coverage gap Patient share generic drugs in coverage gap
2015 45% 65%
2016 45% 58%
2017 40% 51%
2018 35% 44%
2019 30% 37%
2020 25% 25%
Source: CMS, “Closing the Coverage Gap,” January 2015