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. Physicians tend to favor well-established treatments, such as the long-acting muscarinic antagonist (LAMA) Spiriva (Boehringer Ingelheim/Pfizer’s tiotropium) and the long-acting beta2 agonist (LABA)/inhaled corticosteroid (ICS) fixed-dose combination (FDC) Advair (GlaxoSmithKline’s salmeterol/fluticasone propionate), but more options from these drug classes are becoming available. In addition, the first LABA/LAMA FDC, Anoro (GlaxoSmithKline/Theravance’s vilanterol/umeclidinium), has launched, and four more LABA/LAMA FDCs are expected to launch by 2016. Changes in prescribing habits to accommodate these new therapies will strongly depend on the number of different agents in each drug class that payers are willing to reimburse and the restrictions that will be placed on them. 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:

  • Current treatment of COPD: What are the current prescribing patterns for LAMAs, LABA/ICS FDCs, and the available LABA/LAMA FDC? How do these therapies typically fit into the COPD treatment algorithm—are they usually prescribed as monotherapies or as part of multidrug regimens? What factors drive physicians’ prescribing decisions when treating patients with COPD? How have pulmonologists responded to the most recently launched COPD therapies Breo and Anoro?

  • Emerging therapies for COPD: How do pulmonologists envision choosing between the emerging LABA/LAMA FDCs? Where in the treatment algorithm will this new drug class fall? How will the launch of additional LAMAs and generic Spiriva affect the LABA/LAMA FDCs? How will pulmonologists differ in their LABA/ICS FDC prescribing decisions when generic versions of Advair and Symbicort are available? What factors will drive physician prescribing of LABA/ICS FDCs?

  • Dynamics of the U.S. reimbursement environment for COPD: How does payer coverage of later-to-market agents compare with more well-established therapies? How many LABA/LAMA FDCs do payers ultimately expect to place on formulary? What factors will support favorable reimbursement status of a COPD drug over a competing agent? What kind of payer restrictions can emerging bronchodilators expect to face? At what price points will novel therapies most likely gain favorable formulary status?


This U.S. Physician & Payer Forum investigates payer and physician dynamics that affect prescribing practices for therapies for COPD in the United States. The report is based on a survey of 103 pulmonologists and 30 pharmacy and medical directors (PDs and MDs) at managed care organizations (MCOs) that offer commercial health insurance. We explore the factors that shape current and future treatment patterns as well as reimbursement trends in COPD. Additionally, this report reveals pulmonologists’ and payers’ perceptions of bronchodilators that are currently available or will launch in the United States over the next few years, including Novartis’s Ultibro (indacaterol/glycopyrronium), Boehringer Ingelheim’s olodaterol/tiotropium, AstraZeneca’s formoterol/glycopyrronium, Actavis’s formoterol/aclidinium, and GlaxoSmithKline/Theravance’s Incruse (umeclidinium).

Markets covered: United States.

Primary research: Online survey of 103 pulmonologists and 30 MCO PDs/MDs.

Epidemiology: 2014-2022 diagnosed prevalent cases of COPD in the United States.

Author(s): Colleen E. Albacker, Ph.D.