Accountable care organizations (ACOs) will likely have a more immediate impact on prescribing trends in asthma and COPD than they will in other common conditions such as cancer because payers and providers alike see these chronic lung disorders as a treatment arena ripe for improvements in both cost savings and health outcomes. The adoption of the ACO model is spreading from its origins in the Medicare system into the realm of commercial health plans. ACOs are making pulmonologists more conscious of the long-term consequences of each prescribing decision by linking their reimbursement to the achievement of goals such as reducing hospital readmissions and total medical costs as well as saving on prescription drug costs. As physicians balance these often-competing goals, they prescribe more medications earlier in the course of treatment for asthma and COPD to avoid costly hospital stays. Among the products benefiting from the additional sales are two widely used drug classes, ICSs and LABA/ICSs, which are called “controller” or “maintenance” drugs because they prevent acute exacerbations that can prompt hospital visits. ACOs also plan to monitor patient adherence to these and other drugs—another factor likely to increase sales. However, the ACO focus on cost-cutting drives many of these additional sales to generic competitors of brand name drugs. Among the controller drugs, ACOs may even spur a movement away from the brand-dominated LABA/ICS class [GlaxoSmithKline’s Advair (salmeterol/fluticasone propionate), AstraZeneca’s Symbicort (formoterol/budesonide), and Merck’s Dulera (formoterol/mometasone furoate)] to reach the generic alternatives available in the ICS class (generic Budesonide nebulizer). Branded drug marketers can use a variety of means to protect market share in the challenging ACO environment. Within drug classes, some branded drugs may be distinguished by an active agent different from the generic in that class. For example, GlaxoSmithKline’s Flovent is an ICS agent different from the generic drug budesonide. GSK’s Advair has the same ICS agent as Flovent and, as a combination LABA/ICS drug, Advair arguably promotes adherence compared with the use of two drugs administered separately. However, the LABA/ICS class is vulnerable because of FDA warnings about LABA side effects. Drug marketers should be prepared to point out any brand advantages such as low side effects, ease of use, convenient delivery devices for inhaled drugs, and superior improvements on the health screening tests most frequently used for ACO monitoring. In addition, many brands might need to preserve their place in ACO formularies by discounting prices under contracts favorable to ACOs.
This U.S. Physician & Payer Forum reveals physicians’ and payers’ insights into the changes in prescribing practices in the United States for asthma and COPD drugs due to participation in ACOs. The report is based on a survey of 100 pulmonologists, 39 MCO pharmacy directors, and 2 MCO medical directors at MCOs that either currently contract with ACOs or expect to do so within 12 months. We highlight reimbursement arrangements, formulary restrictions, metrics tied to provider compensation, and other factors that influence decisions to use branded drugs or generic alternatives. The report explores opportunities for drug developers to advocate for their brands consistent with ACO goals and to protect or expand their market share. Specific therapies examined within the ACO context include GlaxoSmithKline’s Flovent and Advair; AstraZeneca’s Pulmicort and Symbicort; Teva’s QVAR; Merck’s Dulera and Singulair; and Boehringer Ingelheim’s Spiriva and Atrovent.
- Markets covered: United States.
- Primary research: Online survey of 100 pulmonologists, 39 MCO pharmacy directors, and 2 MCO medical directors.
- Population segments: Our analysis involves patients covered under Medicare, Medicaid, and commercial health plans. The report also reflects on potential changes in prescribing for patients with lung disorders at different stages of severity, such as intermittent asthma and persistent asthma.