Views on US physician prescribing and payer reimbursement across multiple neuropathic pain populations

Expanded labeling for additional neuropathic pain (NP) populations and/or broader NP labeling (peripheral NP) will not ensure increased physician prescribing or improved formulary coverage, according to a new study from health care advisory firm Decision Resources.

Instead, the survey findings reveal that US primary care physicians, pain specialists and neurologists are comfortable prescribing NP therapies to an array of NP populations for which the agents are not specifically labeled, and the majority of surveyed managed care organization (MCO) directors will reimburse these therapies for any form of NP, at the physician’s discretion.

“Most surveyed payers recognize the difficulty in treating NP and agree that reimbursement for NP will be less restrictive than reimbursement for other forms of chronic pain,” said Decision Resources principal business insights analyst Andrea Buurma, adding: “However, newer agents like Depomed’s Gralise [gabapentin] and XenoPort’s Horizant [gabapentin enacarbil] face more restrictive coverage on surveyed payers’ commercial plans and Medicare prescription drug plans, likely because these agents’ parent molecule, gabapentin, is available generically and has widespread, favorable formulary coverage.”