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Survey: ACOs Could Generate Savings of at Least 12% in Asthma and COPD

Lower-cost therapies, screenings, and drug compliance will drive savings efforts (July 10)

Decision Resources, a research and advisory firm based in Burlington, Mass., finds that both pharmacy directors at managed care organizations (MCOs) and pulmonologists believe that accountable care organizations (ACOs) can generate medical and drug cost savings of at least 12% in asthma and chronic obstructive pulmonary disease (COPD).

The report finds that pulmonologists currently participating in or expecting to soon join an ACO anticipate that ACOs can (on average) reduce drug costs by 12% and medical costs by 13% for asthma and COPD, while MCO pharmacy directors and medical directors project savings of nearly 15%.These savings will result from ACOs’ focus on prescribing lower-cost therapies, patient screenings, and drug adherence. To accomplish this, MCOs’ contracts with ACOs will tie compensation to physicians meeting metrics that improve outcomes and reduce costs — the underlying goals of ACOs.

The report indicates that although ACOs will promote generic therapies, their focus on medical costs and on reducing hospitalizations will play a larger role in prescribing decisions. Forty-three percent of pulmonologists indicated they would prescribe mometasone furoate (Dulera, Merck) to fewer of their patients because they participate in an ACO. In comparison, fluticasone propionate (Advair, GlaxoSmithKline) faces a less challenging environment because some stakeholders perceive the active ingredient as more effective for moderate-to-severe asthmatics.

The report also finds that ACOs do not currently have distinct formularies but probably will within the next 3 years. Only 13% of the pulmonologists surveyed who currently participate in an ACO reported a distinct ACO formulary, driven by the shortage of lives within the ACO. These physicians — who currently serve an average of 10,000 patients in their ACOs — estimated they would need 30,000 members to justify their own formulary. Similarly, 72% of MCO pharmacy directors foresee that their ACOs will develop their own formularies distinct from the MCO formulary within 3 years.

“Clearly, the distinct ACO formulary is coming. Drug marketers must identify and negotiate with those ACOs that have their own drug lists, or they risk losing patient share to other branded therapies and generics,” said analyst Roy Moore.

Source: Decision Resources; July 10, 2013.

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