A Survey of Pulmonologists and Managed Care Organization Pharmacy and Medical Directors

The U.S. market for chronic obstructive pulmonary disease (COPD) therapies consists entirely of symptomatic treatments, namely bronchodilators and anti-inflammatory agents, which improve patients’ quality of life (QOL) but do not alter the natural history of the disease. Surveyed physicians tend to favor well-established treatments, such as the long-acting muscarinic antagonist (LAMA) Spiriva (Boehringer Ingelheim’s Spiriva) and the long-acting beta2 agonist (LABA)/inhaled corticosteroid (ICS) fixed-dose combination (FDC) Advair (GlaxoSmithKline’s salmeterol/fluticasone propionate). In addition, alternative FDCs such as Anoro (GlaxoSmithKline/Theravance’s vilanterol/umeclidinium) are beginning to gain market share, and generic versions of popular agents are expected in the coming years. Changes in prescribing habits to accommodate the new therapies are expected, and payers will likely update their formularies to accommodate the launch of multiple FDCs and generics. In this report, we gauge physicians’ and payers’ opinions of current and emerging therapies for COPD to anticipate potential changes in the prescribing patterns and reimbursement climate.

Questions Answered in This Report:

  • Several LABA/LAMA and LABA/LAMA/ICS FDCs are currently in clinical trials, and some LABA/LAMA FDCs are already available. These single-inhaler agents are likely to present an appealing option for patients receiving several drugs and currently forced to juggle multiple devices. How will the launch of novel FDCs impact the treatment algorithm? What can manufacturers do to promote uptake?

  • Generic versions of market leaders Advair, Symbicort, and Spiriva are expected to launch by 2019, reducing costs for many COPD patients. These generics are likely to have effects beyond just these branded agents, altering usage of other LAMAs and LABA/ICS FDCs, as well as novel agents. How will the treatment regimens change in reaction to generics? What proportion of patients will receive branded and generic agents by 2019? Do pulmonologists have any hesitations about prescribing generics to their patients?

  • As more COPD therapies come on the market, physicians and payers will have a range of options to include on formulary and in treatment regimens, with multiple alternative LABA/LAMA FDCs in addition to LAMAs and LABA/ICS FDCs competing for market share. What factors are most important for physicians when making treatment decisions? What factors are considered when determining formulary placement? How many novel FDCs do payers expect to include on formulary?


This U.S. Physician & Payer Forum investigates payer and physician dynamics that affect prescribing practices for therapies for COPD in the United States. This report is based on a survey of 99 pulmonologists and 30 pharmacy and medical directors (PDs and MDs). We explore the factors that shape current and future treatment patterns as well as reimbursement trends for COPD. Additionally, this report reveals pulmonologists’ and payers’ perceptions of bronchodilators that are currently available or will launch in the United States in the next few years, including Novartis’s Ultibro (indacaterol/glycopyrronium), Boehringer Ingelheim’s Stiolto (olodaterol/tiotropium), AstraZeneca’s formoterol/glycopyrronium, AstraZeneca’s Duaklir (formoterol/aclidinium), and GlaxoSmithKline/Theravance BioPharma’s vilanterol/umeclidinium/fluticasone furoate.

Markets covered: United States.

Primary research: Online survey of 99 pulmonologists and 30 MCO PDs/MDs.

Epidemiology: 2015-2023 diagnosed prevalent cases of COPD in the United States.

Author(s): Kristine Mackin, Ph.D.