Decision Resources, Inc., one of the world's leading research and advisory firms for pharmaceutical and health care issues, finds that HMOs already use or are likely to use specific cost control measures relative to Remicade therapy for the treatment of Crohn's Disease. Nearly 60% of HMO pharmacy directors surveyed indicate that they already require authorization prior to initiation of Remicade therapy as a cost control measure, while 40% already require a step-care approach to Remicade therapy. According to the new PhysicianForum report entitled Crohn's Disease: Physician and Payer Acceptance of Early Biologics Use, many HMOs indicate that increases in coinsurance or patient copayments are also somewhat likely.
Trying and failing other therapies is one measure that HMOs have taken to relieve the cost burden of Remicade.
"Approximately half of HMO pharmacy directors say that their health plans require Crohn's disease patients to try and fail therapy with conventional agents prior to Remicade use," says Stephanie Krebs, analyst at Decision Resources. "Oral aminosalicylates, oral coricosteroids, and topical aminosalicylates are the agents HMO pharmacy directors cite as the conventional agents that must be tried and failed prior to the initiation of Remicade therapy."
Crohn's Disease: Physician and Payer Acceptance of Early Biologics Use is based on a U.S. survey of 31 managed care pharmacy and medical directors and 116 gastroenterologists. Their responses were compared to assess similarities and differences of opinion regarding clinical, economic, and scientific factors.
PhysicianForum is a primary research service from Decision Resources that offers access to high volume-prescribing physicians, specialists, and managed care organization representatives in the United States; analysis of events and survey participants' responses to them; insight into prescribing patterns; and an examination of the implications of events and issues for the pharmaceutical market.
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