HealthLeaders-InterStudy and Fingertip Formulary find that 90 percent of surveyed pharmacy directors intend to reimburse Amgen's Prolia when the injectable treatment for osteoporosis is launched in 2010. However, according to the new Formulary Forum report entitled Formulary Advantages in Osteoporosis: Rise and Fall of Access in the Wake of Fosamax Generics, Rebate and Contracting Efforts, and New Drug Launches, more than a quarter (28%) of those surveyed say they do not know how their managed care organization will tier Prolia.
When looking at the impact of price on tier status, if Prolia is priced at a ten percent discount relative to Eli Lilly's Forteo, only 12 percent of surveyed pharmacy directors say their managed care organizations' commercial plan would reimburse the drug on Tier 1 or Tier 2. At the same price point on their Medicare plans, surveyed pharmacy directors are evenly split as to whether they would reimburse Prolia as a Tier 3 or 4 benefit, but 34 percent of surveyed pharmacy directors say their managed care organization would not include Prolia on their Medicare formularies at this price.
"Forteo is most commonly covered as a Tier 2 benefit on commercial plans and on Tier 4 (or higher) on Medicare plans, so our survey findings suggest Prolia will have disadvantaged status compared with its next closest competitor," said Michael Malecki, Ph.D., product manager for Formulary Forum. "New classes of agents are typically reimbursed, but more surveyed pharmacy directors say they would not add Prolia to their commercial and Medicare formularies if it is priced equal to or above the net price of Forteo, indicating managed care organizations may shy away from novel therapies for this indication if they are priced at a premium."
The new Formulary Forum report is based on a survey of 50 U.S. pharmacy directors who control formularies at national, regional and state-level managed care organizations, as well as historical formulary data from Fingertip Formulary.
About Fingertip Formulary
Fingertip Formulary (www.FingertipFormulary.com), the leading provider of access to and insight into formulary data in the United States, offers comprehensive formulary data covering commercial, Medicaid, Medicare and PBM plans, among others. Fingertip Formulary is a Decision Resources, Inc. company.
HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.
About Decision Resources, Inc.
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SOURCE: HealthLeaders-InterStudy; Fingertip Formulary
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