Market access risk in respiratory medicine

Breathing disease is paid for in flare-ups. Asthma, COPD and bronchiectasis are chronic, common and mostly controlled by inhalers that cost little — so the expensive medicines of the field, the biologics given by injection every few weeks or months, are reimbursed for the patients whose disease keeps breaking through: counted in exacerbations, hospital stays and courses of steroids. The fibrosing lung diseases pose the opposite problem, a slow decline measured by a breathing test that payers must translate into years of life. And cystic fibrosis, where a lifetime therapy transformed the disease, remains the field's lesson in what a small population and a very high price do to a national budget. This page brings together MARA's independent assessments of reimbursement risk across the field.

What payers ask in respiratory medicine

How many flare-ups does it prevent, and in whom? Exacerbations — the flare-ups that send a patient to the emergency department — are the currency of respiratory reimbursement. Payers ask how many the drug prevents, how they were counted, and whether the patients in the trial were the frequent flarers the payer intends to cover, or a broader group.

Which biomarker opens the door? Blood eosinophil counts and other markers define who responds to the newer asthma and COPD biologics. Payers write those thresholds into eligibility, often more tightly than the label, so the reimbursed population is a biomarker-defined slice of the disease — and the price is judged against that slice.

Does the breathing test stand for the patient? In the fibrosing lung diseases, approval rests on the rate of decline in forced vital capacity, a measure of lung volume. Payers accept it where it tracks survival and ask, where it does not, what the patient reported — breathlessness, cough, the ability to climb stairs — before they attach a price to a litre of air.

What is a longer dosing interval worth? The asthma biologics now compete on how rarely they are given, from fortnightly to twice a year. Payers acknowledge the gain for patients and clinics, and still price the new entrant against the class it joins — convenience earns parity, and only new evidence earns a premium.

The MARA record in respiratory medicine

Respiratory medicine holds a dozen dated assessments in the MARA catalogue: the biologic classes in severe asthma, new maintenance treatments in COPD, idiopathic and progressive pulmonary fibrosis, non-cystic fibrosis bronchiectasis and the cystic fibrosis modulators. Each report answers the same payer questions, carries its "as of" date, and stays on the record — when the evidence moves, a newer vintage replaces the older one visibly, never silently. Assessments are produced on MARA's own initiative for awareness; the current MARA Rating for any drug is available on request.

Current assessments (11)

Earlier assessments (each replaced by a newer version)

Nerandomilast for idiopathic Pulmonary Fibrosis as of February 2026

Selected commentary

For how a MARA Rating is built, see the methodology and what a MARA Rating is. To request the current rating for any drug in this area, use the contact form.