Surveyed Pulmonologists and Payers Anticipate More Controls on Branded Asthma Drugs in Exchange-Based Plans than Commercial Plans

March 5, 2014

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."

Upcoming webinar:

    --  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

About Decision Resources Group

Decision Resources Group is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources Group at www.DecisionResourcesGroup.com.

All company, brand, or product names contained in this document may be trademarks or registered trademarks of their respective holders.

For more information, contact:

Decision Resources Group

Christopher Comfort



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SOURCE Decision Resources Group

Source: PR Newswire

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