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 $1 billion by 2022.
Market size ($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|
|Source: CMS, “Closing the Coverage Gap,” January 2015|