Health Strategies Group 1/12/2019 Health Strategies Group Author/Artist Key Finding #4 Access Risks for Brands Will Continue to Rise as Market Competition and Resulting Stakeholder Management Grow Projected Access Impact by 2020 Evolving Market Dynamics Impacting MS Drug Access Availability of multisource generics for high-volume brands, posing substantial competition to reference brands Given sizable pricing advantages upon multisource availability of glatiramer acetate (Copaxone) and fingolimod (Gilenya), stakeholders will take advantage of competition to bring down costs. High Growing adoption of increasingly aggressive management, including leveraging of member cost-sharing differentials, step therapy, PAs, PDLs, and broader coverage exclusions While some flexibility will remain in treatment choice for hard-to-treat patients, plans will leverage brand competition and generics to drive use to preferred drugs; clear brand value propositions will be critical. Moderate-High Continued acceptance of large contract incentives and competitive rates from companies producing MS drugs, as well as potential emergence of risk-based contracts to differentiate drugs Contracts for preferred brands within competitive classes (e.g., interferons) will limit access for competitors; growing competition will create need for novel contracting strategies. Moderate-High Entrance of additional branded MS drugs, increasing competition within mechanisms of action and/or modes of administration Brands that fail to demonstrate substantial long-term efficacy in real-world settings will likely face access barriers relative to more efficacious brands. Moderate-High Development and implementation of treatment guidelines and protocols across stakeholders and by specific MS indications The approval of new drugs with never-before-available indications (e.g., primary progressive MS, secondary progressive MS) will begin to drive use of guidelines to steer drug use by diagnosis. Moderate Abbreviations: PA, prior authorization, PDL, preferred drug list. Source: Health Strategies Group, Brand Access Marketplace Dynamics, June 2018.