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Report: Uptake of Obesity Drugs Will Be Hampered by Managed Care Formulary Exclusion

Victoza (liraglutide) foreseen as new market-share leader (Apr. 16)

A survey conducted by Decision Resources, a research and advisory firm based in Burlington, Mass., finds that nearly one half of surveyed managed care organization (MCO) pharmacy and medical directors in the U.S. currently exclude or block access to all weight-loss drugs, and one-third will not cover an obesity drug without a demonstration of long-term benefit.

These market-access hurdles represent significant barriers to the uptake of new obesity drugs, such as Qsymia (phentermine/topiramate, Vivus) and Belviq (lorcaserin, Arena/Eisai), despite the high level of unmet need for safe and effective obesity treatments, the findings suggest. Surveyed prescribers estimate that approximately 40% of their patients do not receive a weight-loss drug because of formulary tiering or MCO restrictions.

The survey also finds that nearly two-thirds of surveyed endocrinologists and primary care physicians (PCPs) expect to increase their prescribing of Qsymia over the next year. However, Victoza (liraglutide, Novo Nordisk) will likely become the leader in the obesity market, owing to physician familiarity with the drug’s use in type 2 diabetes and current experience with off-label prescribing of the drug for obesity. The survey results show that endocrinologists expect to prescribe Victoza to 20% of their obese and overweight patients in 2015.

In additon, the report finds that Qsymia and the phase III drug Contrave (bupropion/naltrexone, Orexigen/Takeda) are vulnerable in the obesity market because of the willingness of surveyed physicians to prescribe generic components instead of the branded fixed-dose combinations. In addition, surveyed PCPs continue to view phentermine (Adipex-P, Teva; and generics) as the most efficacious weight-loss drug; 59% of PCPs anticipate prescribing phentermine first-line in 2015.

“Surveyed endocrinologists and PCPs estimate that fewer than 26% of their overweight and obese patients request a specific weight-loss drug,” said analyst Donny Wong, PhD. “As a result, despite Qsymia’s status as the newest obesity drug to launch in the United States since Roche’s Xenical and Abbott’s Meridia, phentermine remains the most commonly prescribed obesity drug. However, the heavy use of phentermine in the United States may provide an opportunity for patients to be ‘upgraded’ to Qsymia, or to try combination therapy with Belviq once that option becomes available.”

Source: Decision Resources; April 16, 2013.

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