How Payers View Pfizer Inc. (PFE)'s Rheumatoid Arthritis Pill  
5/15/2012 7:55:15 AM

An FDA panel may have recommended a new Pfizer pill for rheumatoid arthritis last week, but of course, the drugmaker must still win over regulators, doctors and payers. And while Wall Street is betting the FDA will approve tofacitinib, convincing payers of its worth may prove more difficult. Although pricing will be a major determinant in coverage, it is clearly not the only factor. How so? A new survey finds that nearly 39 percent of managed care entities will require patients to first fail at least two other treatments – such as the Humira or Enbrel anti-TNF inhibitors – before providing coverage. But only 27 percent held the same view before the FDA advisory committee met last week. Why? The FDA panel noted it was not possible to make conclusions about the effect of tofacitinib on the progression of structural damage in RA.