Surveyed Pulmonologists and Payers Anticipate More Controls on Branded Asthma Drugs in Exchange-Based Plans than Commercial Plans
Asthma Drugs Face More Scrutiny in Insurance Exchanges, According to Findings from Decision Resources Group
BURLINGTON, Mass., March 5, 2014 /PRNewswire/ — Decision Resources Group finds that as the Affordable Care Act drives up the demand for asthma drugs, exchange-based plans will impose more cost controls and prescribing barriers than commercial plans, although the differences may not be dramatic. Results of a survey of 100 pulmonologists and 40 medical directors and pharmacy directors of managed care organizations (MCOs) indicate that 45 percent of MCOs planned to have separate formularies for the exchanges, and of them, 78 percent expected the formularies to cover fewer branded drugs.
Other key findings from the U.S. Physician & Payer Forum report entitled Healthcare Reform and Asthma: How Should Brand Marketers Adapt to the Launch of Exchanges and Expanded Medicaid?:
-- Flovent, Advair and Symbicort: Market-leading branded asthma inhalers, such as GlaxoSmithKline's Flovent and Advair and AstraZeneca's Symbicort continue to lead prescribing among pulmonologists and receive the most favorable treatment by MCOs than competing brands, although support will fall dramatically when patents start to expire in 2015. -- Breo: GlaxoSmithKline's Breo, an emerging chronic obstructive pulmonary disease therapy distinguished by its once-daily inhaled dosing, will likely appear on non-preferred tiers on most exchange-based formularies once it's approved for asthma, which will reduce the prescribing rate among pulmonologists. -- Patient discount programs: Surveyed specialists and MCO officials say they generally support patient discount programs for branded asthma drugs, particularly if it can be demonstrated these programs increase medication compliance and reduce downstream healthcare costs. Although MCOs would restrict access to coupons through step therapy and prior authorization, few surveyed PDs/MDs expect their MCO to exclude these drugs from coverage. -- Medicaid: The expansion of Medicaid through the Affordable Care Act and the increased use of MCOs to manage this program have financially constrained MCOs, resulting in removal of more branded drugs from Medicaid preferred drug lists.
Comments from Decision Resources Group Analyst Chris Lewis:
-- "As the Affordable Care Act expands access to Medicaid and exchange-based coverage for many more asthma suffers, these drugs will be in higher demand. But just as financial constraints have led MCOs to use more narrow-network providers to control medical expenses, many MCOs are also trimming formularies and adding restrictions to curb the use of branded drugs, thereby increasing pressure on branded drug marketers to increase discounts or lower prices to maintain favorable coverage." -- "Considering the backlash against discount drug coupons among payers, the broad support for coupons for asthma drugs among prescribers and MCOs was somewhat surprising and probably reflects the lack of generic alternatives for the popular inhalers. Although MCOs intend to impose controls on brands associated with coupons, they do not intend to block coverage altogether."
-- Media members are welcome to attend our upcoming webinar based on this report entitled A New Channel for Asthma Drugs: How the Launch of Health Exchanges Will Affect Reimbursement and Prescribing of Branded Agents. This presentation will be held on Thursday, April 10, 2014. For more information, please contact Christopher Comfort at firstname.lastname@example.org.
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