Physician and Payer Perspectives on Prescribing and Patient Access

China has long wrestled with an increasing prevalence in respiratory diseases that has accompanied its economic growth and development. As a result of poor air quality, the overall disease burden of asthma in China has increased among the rapidly urbanizing population of 1.3 billion. Today, China has the world’s highest asthma mortality rate, according to the Asia Asthma Development Board. Unfortunately, treatment options for asthma patients remain similar to those available ten years ago. The market is dominated by long-acting beta2 agonist/inhaled corticosteroid fixed-dose combinations (LABA/ICS FDCs). Many newer drugs, which are available in mature pharmaceutical markets, such as the once-daily LABA/ICS FDC Relvar (GlaxoSmithKline’s vilanterol/fluticasone), and targeted therapies such as Xolair (Novartis’s omalizumab), are not yet available in China, leaving pulmonologists desperate for novel treatments that can help patients achieve better disease control. The likely high cost of emerging therapies will be met with payer-imposed reimbursement restrictions. New therapies will also have to contend with the impending entry of generic versions of key therapies. In the current economic climate, drug manufacturers must overcome these and other challenges to gain access to China’s increasingly cost-conscious pharmaceutical market.

Questions Answered in This Report:

  • How often are physicians prescribing ICS monotherapy versus LABA/ICS FDCs?

  • Which agents are included in the NRDL and/or Provincial Reimbursement Drug Lists (PRDLs) today, and what reimbursement restrictions apply?

  • How will payer policy (e.g., inclusion in government formularies/drug lists) actually affect the uptake of emerging agents?

  • How do reimbursement restrictions affect the prescribing of current therapies? How might reimbursement of currently approved FDCs change in the near future?

  • How familiar are physicians and payers with the LABA/ICS FDC Relvar? How will pulmonologists receive Relvar assuming its approval in the Chinese market?

  • What are payers’ and pulmonologists’ perception of the biologic Xolair for the treatment of severe asthma?


Decision Resources Group’s Emerging Physician & Payer Forum report “Positioning of Current and Emerging Agents for Asthma in China: Physician and Payer Perspectives on Prescribing and Patient Access” explores the prescribing patterns of current asthma therapies, the potential impact of the anticipated arrival of generic FDCs, and key national and regional market access factors that will shape the use of novel asthma drugs in China over the next two to three years. This report draws on insights from 51 surveyed pulmonologists and from interviews with three payers in China, all of whom have influence at a national or regional level. Interviewed payers are as follows:

- NRDL panel member, Beijing: Hospital chief physician, hospital expert group member.

- NRDL panel member, Anhui: Hospital chief physician, member of the China Respiratory Physicians’ Association.

- NRDL panel member, Henan: Director of respiratory medicine, president of Henan Respiratory Physicians’ Association, chairman of Henan allergy association committee.

Author(s): Jonathan Chan, M.MedSc.

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