Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) have access to more than a dozen long-acting bronchodilator inhalers, ranging from blockbusters like GlaxoSmithKline’s (GSK’s) Advair, AstraZeneca’s Symbicort, and Boehringer Ingelheim’s Spiriva to newer combination inhalers such as GSK’s Anoro Ellipta and Trelegy Ellipta (the first triple combination) and Boehringer Ingelheim’s Stiolto Respimat. Despite the competition, the cost of inhalers remains high, about $400-500 a month, presenting an affordability challenge particularly for seniors in high-deductible Medicare Advantage plans. Amid the recent entry of generic salmeterol / fluticasone, the COPD market is still developing as new products seek to improve efficacy, as well as dosing convenience. This report examines the reimbursement and prescribing environment for current and select emerging COPD drugs, with a special focus on patient affordability of inhalers in Medicare Advantage plans with prescription drug coverage (MAPD).
- What attributes drive favorable reimbursement of branded inhalers on MCOs’ largest MAPDs and market uptake by pulmonologists, and how do generics impact the market?
- How often are pulmonologists made aware of their patients’ difficulties in affording COPD therapy, and what are the negative effects on adherence and exacerbations?
- What do managed care organization(MCO) directors consider the most feasible strategies to address the affordability issues facing Medicare members with COPD? What are the market-access prospects for AstraZeneca’s emerging Breztri Aerosphere if it is FDA-approved as the second triple-combination inhaler after GSK’s Trelegy?
Geography: United States
Primary research: Surveys of 100 U.S. pulmonologists and 41 U.S. MCO pharmacy and medical directors
Fingertip formulary: Formulary coverage data of COPD therapies by Medicare Advantage prescription drug plans covering 14.8 million lives nationally.
Key drugs covered: Advair, Symbicort, Dulera, Breo, AirDuo, Spiriva, Tudorza, Incruse, Seebri, Anoro, Stiolto, Bevespi, Utibron, Dualir, Trelegy, Breztri
Reimbursement and contracting
Access and prescribing
Opportunities and challenges for emerging therapies
Disease-specific special topic
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.
- Chronic Obstructive Pulmonary Disease - Access & Reimbursement - Detailed, Expanded Analysis (US) Inhaled COPD Therapies
- Access & Reimbursement COPD US April 2020
Author(s): Chris Lewis
Chris Lewis serves as primary research manager, U.S. Access and Reimbursement, with responsibility for coordination, content review and content generation of the market access and reimbursement insights at DRG. Content is based on online surveys of managed care organizations and physicians and expert analysis of reimbursement and prescribing patterns of key therapies treating various disease states.
Lewis was an analyst/senior analyst for the group’s HealthLeaders-InterStudy subsidiary for eight years, specializing in the managed care and pharmacy benefit management industries. Throughout her tenure, she has produced the Health Plan Analysis reports for California, New York, New Jersey, Connecticut, and Pennsylvania and authored DRG’s series of pharmacy benefit manager profiles. She has also conducted numerous webinars for the group. She is a seasoned journalist with a B.A. in communications from California State University, Sacramento.