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Survey: Payers Expect to Limit Hospital Use of New Premium-Priced Antibiotics for Gram-Negative Infections

Pricing will be key factor in hospital formulary uptake

Decision Resources Group, a health care research firm located in Burlington, Mass., has found that most surveyed infectious disease (ID) specialists and internists were willing to prescribe ceftazidime/avibactam (CAZ-AVI, Actavis), ceftolozane/tazobactam (Cubist), or eravacycline (Tetraphase) for the treatment of Gram-negative infections (GNIs) in the hospital setting.

A comparison of anticipated prescribing for emerging cephalosporin/beta-lactamase inhibitor combinations indicated that ID specialists were more likely to prescribe CAZ-AVI than ceftolozane/tazobactam, suggesting that the clinical profile of CAZ-AVI and its spectrum of activity resonated with ID specialists.

However, hospital pharmacy directors indicated that drug pricing will be central to formulary positioning of these new agents for GNIs; cost-conscious pharmacy directors expected to impose a variety of prescribing restrictions and even to exclude CAZ-AVI, ceftolozane/tazobactam, and eravacycline from formularies if these agents are priced at a premium to current brands.

The survey also found that inexpensive, generically available drugs —piperacillin/tazobactam and the fluoroquinolones — remain the mainstay therapies for hospital-treated GNIs. However, the increasing rates of drug resistance in GNIs is resulting in first-line use of more potent antibiotics and in earlier treatment with traditional later-line agents, such as the carbapenems.

Surveyed physicians and hospital pharmacy directors reported current formulary status and associated prescribing restrictions for key GNI agents; approximately 60% of represented hospitals did not impose prescribing restrictions for meropenem (Merrem IV, AstraZeneca), underscoring the overall uptake of carbapenem prescribing.

Although less than half of surveyed physicians and pharmacy directors reported awareness of the proposed Limited Population Antibacterial Drugs (LPAD) regulatory pathway, both groups were willing to accept high-priced LPAD therapies if these agents can demonstrate benefits in select efficacy and outcomes-based parameters.

“Hospitals continue to look for ways to contain spend, including their pharmacy expenditures,” said analyst Brenda Perez-Cheeks, PhD. “With increasing emphasis on health outcomes and hospital reimbursement rates tied to quality of care and rates of hospital-related complications, novel agents that demonstrate improvements in efficacy outcomes, reduce readmission rates for key HTIs [hospital-treated infections], and decrease the length of hospitalization could see elevated uptake despite premium pricing.”

Source: Decision Resources Group; September 25, 2014.

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