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Survey Finds Prescribing Behavior Affected by Insurance Exchanges and ACOs

Health care reform affects market access for pharmaceutical brands (October 24)

Based on a recent survey of physicians and managed care organization (MCO) executives, Decision Resources Group, a research and advisory firm located in Burlington, Mass., finds that pharmaceutical companies are facing a paradigm shift in the way their brands gain access to the U.S. market as accountable care organizations (ACOs) continue to develop across the nation and enrollment on the health insurance exchanges moves forward.

“When we looked at currently available and emerging brands by therapy, it was clear that some will benefit and others will be challenged,” said analyst Roy Moore. “For instance, looking at schizophrenia and depression, physician and payer responses suggest constrained use of branded therapies on exchange-based plans because of generic competition — even though they feel Abilify [aripiprazole, Otsuka] and Cymbalta [duloxetine, Eli Lilly] will remain popular therapies.”

ACOs, of which there are more than 500 across the U.S., will also affect prescribing behavior and brand uptake across therapies, the report finds. For example, half of surveyed pulmonologists who participate in an ACO reduced their prescribing of the branded leukotriene inhibitor Singulair (Merck Sharp & Dohme) — while one-third assigned more of their patients to montelukast, a generic form of the same drug favored by ACO policies, such as co-pay reductions. Similarly, 43% report they are less likely to prescribe Dulera (mometasone fuorate/formoterol fumarate dihydrate, Merck Sharp & Dohme) because of their participation in an ACO, whereas only 13% report increased prescribing of this agent.

Yet the findings show that ACOs did not universally push physicians to generics — pulmonologists are evenly split in whether they increased or decreased the prescribing of Advair (fluticasone propionate/salmeterol, GlaxoSmithKline), a competing combination therapy, highlighting how a brand can withstand the challenges stemming from new reimbursement models.

Source: Decision Resources; October 24, 2013.

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