April 09, 2020
Specialty Physicians Predict More Pain Ahead in the Battle Against COVID-19
The impact to practices has been severely disruptive, taking a devastating personal and financial toll on specialty physicians according to the latest update from Spherix Global Insights
EXTON, Pa., April 9, 2020 / PRNewswire / – Special Report: Multi-Specialty Impact of COVID-19 is an independent project being run by Spherix to assess the impact of the COVID-19 crisis on dermatologists, gastroenterologists, nephrologists, neurologists, and rheumatologists. Each Friday, over 250 specialists are surveyed about impact, concerns, shifting treatment patterns, and critical practice management changes that are resulting from the COVID-19 pandemic. The results have been sobering. In the third wave, based on the responses of 252 specialists gathered on April 3rd, the impact to physicians has been intense and escalating. Notably, office visits are down by at least 80% from normal, and despite the rapid adoption of telemedicine, many note challenges with implementing this service and unclear reimbursement from commercial payers. Though telemedicine consults have seen successive increases each week, it is not coming close to bridging the gap, and some specialties are having a more difficult time than others.
The offset to patient volume is placing enormous financial strain on office-based practices, particularly for dermatologists and gastroenterologists who are heavily reliant on elective procedures. Many have been forced to furlough staff and, in some cases, implement layoffs. With the expectation that this crisis will continue for another 8-9 weeks, many are questioning whether or not their practice will survive; those in smaller practices are most concerned. On a positive note, between Wave 2 (fielded March 24) and Wave 3 (fielded April 3), the percentage of specialists expecting the COVID-19 stimulus package to help their practice increased from 6% to 23%, but more than one-third are anticipating little to no impact/assistance from the government and the majority give low satisfaction ratings to President Trump’s handling of the crisis.
Across all immune specialties captured (dermatology, gastroenterology, and rheumatology), therapy changes of any kind (initiations/switches) are unlikely – but if they must occur, TNF and JAK inhibitors will likely suffer the most at this time. Drugs associated with being more targeted regarding their immunosuppression and generally considered as having favorable safety profiles may come off the least scathed: Amgen’s Otezla for psoriasis and psoriatic arthritis (PsA) and Takeda’s Entyvio for inflammatory bowel disease (IBD), though the latter will be counter-balanced by tempered use of infusion products. For most leading brands in the autoimmune space, there have been minimal issues with the supply chain, the exceptions being hydroxychloroquine (84% of rheumatologists report issues) and Genentech’s Actemra (34% of rheumatologists report issues). Products that require administration by a healthcare professional, such as Sun Dermatology’s Ilumya for psoriasis, also face a challenging scenario.
While the majority of all immune specialists report they are less likely to trial new brands until the crisis has abated, most major immunology launches should not take more of a hit than their more tenured class counterparts in the space. Indeed, when considering the most recent market entrants in RA (AbbVie’s Rinvoq), psoriasis (AbbVie’s Skyrizi), and IBD (Janssen’s Stelara for UC), the majority of specialists had already had ample exposure to each, either in other indications or from rapid uptake post-launch. It seems that AbbVie in particular is attempting to thwart any launch setbacks for their next generation JAK inhibitor (Rinvoq), as the company was listed the most frequently by rheumatologists as continuing to provide samples via mail and engage in e-detailing platforms. Furthermore, AbbVie was selected with the most frequency across dermatology, gastroenterology, and rheumatology as providing the most COVID-related support/communication at this time; however, it should be noted that gastroenterologists are not feeling the same degree of support as the other aforementioned specialties, even when it comes to AbbVie.
Nephrologists have been a bit more buffered than other specialists with regard to patient volume decreases, as their dialysis population continues to require thrice weekly treatment to survive. However, their patient population – immunosuppressed kidney transplant patients, elderly dialysis patients receiving care in group settings, and a patient base with chronic kidney disease that typically has multiple other co-morbidities – is associated with a significantly higher risk of COVID-19 complications. Over the past two weeks, nephrologists increasingly reported having action plans in place for dealing with a COVID-19 outbreak at a dialysis unit; the vast majority are prepared. Most of those surveyed give high satisfaction ratings to dialysis organizations, such as Fresenius and DaVita, and the American Society of Nephrology, for their communication around COVID-19. Only 22% feel that the pharmaceutical industry is providing a high level of support/communication, and more than half say that increased samples, largely to help bridge patients with financial hardship, would be appreciated.
As with other specialists, approximately one-half of neurologists state they are initiating fewer multiple sclerosis (MS) patients on their first disease-modifying therapy (DMT) or switching patients to new DMTs compared to prior to the COVID-19 outbreak. With this smaller new prescription base in mind, it is still notable that more than half report prescribing less of Genentech’s Ocrevus during this time – well above the percent who report a similar decline in prescribing of the other infusion DMTs, specifically Genzyme’s Lemtrada or Biogen’s Tysabri. While concerns related to immunosuppression are definitely a factor, access to infusion centers and delayed scheduling of next doses may also be playing an increasing role in the decreased use, as three out of five neurologists indicate that at least some patients are having difficulty getting their Ocrevus treatments (compared to only 28% for a high-efficacy oral DMT like Novartis’ Gilenya). As one neurologist appealed, “With respect to DMTs for MS, it would be helpful to get guidance if there is contraindication for patients to proceed with Ocrevus, Gilenya, and Mavenclad. I have patients on these agents currently and I am growing concerned.” Depending upon the length of the outbreak, Genentech should expect to see an outsized impact on their share of the few new prescriptions being written compared to other MS companies.
In the migraine space, in the span of just one week, the percent of neurologists being less likely to use Allergan’s Botox doubled, opening an opportunity for the anti-CGRP preventive therapies (Amgen/Novartis’ Aimovig, Teva’s Ajovy, Eli Lilly’s Emgality) which can be self-administered. With more neurologists wanting pharmaceutical manufacturers to mail samples to their offices, companies marketing anti-CGRP therapies could support such switches by proactively upping sample distribution. Allergan itself should also consider increasing sample distribution of Ubrelvy, their acute treatment for migraine, as three out of four neurologists report patients having at least some issues getting their Ubrelvy prescriptions – higher than that seen for any other acute or preventive brands. Biohaven appears to be getting ahead of delayed prescription fulfillment becoming an influential obstacle, having just partnered with Cove to ensure accessibility of Nurtec ODT through the healthcare company’s telemedicine platform. Neurologists note high concern with patients experiencing acute episodes having access to care as they urge patients to avoid the ER and urgent care centers.
In summary, our frontline healthcare leaders are scared, worried, and frustrated. Collectively they estimate it being 8-9 weeks before things begin to improve and 83% of those surveyed last week expect things to get worse in the next two weeks. In the words of one neurologist, “(My greatest concern is) that it will linger on to some degree for much of the year and dramatically and permanently affect people’s livelihoods, relationships, and dreams.”
About the Special Report
To help stakeholders gauge the degree of impact that the COVID-19 pandemic is having on physicians, Spherix will begin ongoing coverage included in Special Report: Multi-Specialty Impact of COVID-19. A subscription to the Special Report will include a weekly deliverable of data collected from the prior week, with coverage beginning March 20 and continuing through mid-May. Specialty reports are available for dermatology, gastroenterology, nephrology, neurology, rheumatology, and primary care physicians.
About Spherix Global Insights
Spherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.
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