Optum: 5 drugs set to have the biggest impact on payers and patients 

Drug prices healthcare costs pill money
Optum outlines five drugs it says are set to have a big impact on payers. (Getty/Jacoblund)

There are plenty of drugs in the development pipeline, and a new report from OptumRx highlights five products that it expects to make a big splash in the market.

The five drugs included in the report are likely to have a significant impact on insurers, patients and the market based on the likelihood of adoption, efficacy and cost. The products spotlighted are: 

  1. Onasemnogene abeparvovec, a gene therapy under the brand name Zolgensma that was recently approved by the Food and Drug Administration. 

  1. NKTR-181, an opioid that is designed to be less prone to abuse. 

  1. Golodirsen, a treatment for Duchenne muscular dystrophy. 

  1. Upadacitinib, a treatment for rheumatoid arthritis. 

  1. Tafamidis meglumine, a first-in-class treatment for transthyretin amyloid cardiomyopathy under the brand name Vyndaqel. 

Optum released a similar report in April, highlighting five drugs that insurers should be watching this year. One product, golodirsen, was included on both lists. 

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Zolgensma made a splash when, shortly after its approval, the drug’s parent company Novartis slapped a $2.1 million price on the drug. Novartis said it will offer a payment plan for the drug at $425,000 per year for five years.  

The drug treats infants with spinal muscular atrophy (SMA), a chronic illness that impacts one in 11,000 children. Zolgensma, however, would be curative rather than a long-term maintenance treatment, so offering it could ultimately save insurers money, according to Optum’s report. 

That said, it also reflects the trend toward FDA approval of “orphan drugs” that lack competition, according to the report. 

“Zolgensma embodies the continued emphasis on orphan drugs in the drug development pipeline and if approved by the FDA, would be the second gene therapy available,” the researchers wrote. “However, when considering that Zolgensma is a one-time treatment … Zolgensma has the potential to reduce overall costs associated with SMA, and most patients will want to try it.” 

RELATED: CMS mulling outcomes-based ways to address expensive specialty drugs, Verma says 

Other drugs on the list address an unmet need or represent a new approach to an existing concern, according to the report. Golodirsen, Optum notes, offers a treatment for a condition with limited options otherwise. NKTR-18 could be a useful tool as payers and providers both seek to scale back opioid prescriptions. 

What can insurers do to ensure that these new—and expensive—treatments are offered appropriately? Setting clear prior authorization protocols will be key, Optum said in the report, as members with these conditions may actively seek out new or alternative therapies. 

Closely monitoring drugs in development can also allow for more effective formulary planning and ensure that payers are ready to adapt to treatments as pricey as, or pricier than, Zolgensma, according to the report. 

There are also open questions about the efficacy of these emerging treatments, which could offer an opportunity for a value- or outcomes-based pricing model. 

“As payers and employers are tasked with coordinating the best possible care for their population, new drugs can be important for members seeking potentially more effective forms of treatment,” according to the report. “When new products are effective and taken by patients who respond well, overall population health can improve, creating a more productive, healthy workforce.” 

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