Verispan Reports: Spiriva Becoming a Preferred Drug in Managed Care
Spiriva, Boehringer Ingelheim and Pfizer’s treatment for chronic obstructive pulmonary disease, has gained formulary status at 81% of managed care organizations, according to Verispan’s spring 2005 Managed Care Formulary Drug Audit. Launched in May 2004, Spiriva was on only 40% of formularies in the fall 2004 audit. The percentage of managed care enrollees covered by plans listing Spiriva on formulary also increased from 38% to 66% between the fall 2004 and spring 2005 audits.
The Managed Care Formulary Drug Audit is a semiannual study that monitors the formulary status, coverage and reimbursement levels of prescription pharmaceuticals in 46 key therapeutic classes, as reported by the largest, most influential managed care organizations in the United States. Additional metrics monitored by the audit include prior-authorization requirements and prescribing guidelines.
Even more important than formulary status, tier placement is also revealed in the Managed Care Formulary Drug Audit. The latest audit results indicate that 75% of managed care lives covered by HMOs had access to Spiriva at a preferred tier position, compared with 40% in fall 2004. A preferred tier position is defined by Verispan as coverage in a single-tier formulary or coverage on the first or second tier of a multi-tier formulary, which means that patients have lower out-of-pocket costs.
Another Verispan product, Vector One(TM): Payer, allows clients to view payer-level data such as prescription share by patient out-of-pocket cost. Linking the Managed Care Formulary Drug Audit and Vector One: Payer enables pharmaceutical clients to correlate the benefits of formulary placement and tier status with actual prescription market share.
For example, segmenting just those HMOs participating in the Managed Care Formulary Drug Audit, Vector One: Payer shows that 56.2% of Spiriva claims in the first half of 2005 were filled with a patient out-of-pocket cost that was between $15.01 and $30.00, which typically correlates with the second tier at managed care organizations utilizing a multi-tier benefit design. This increased by 13.7 percentage points from the second half of 2004. In addition, in the first half of 2005, 14.3% of Spiriva patient out-of-pocket costs were between $30.01 and $50.00, which is usually associated with the third tier at managed care organizations with a multi-tier benefit design. This decreased by 13.4 percentage points from the second half of 2004.
Vector One: Payer shows that at an individual payer level, there was a drastic change in Spiriva’s patient out-of-pocket costs between the second half of 2004 and first half of 2005 at United Healthcare. Forty-nine percent of Spiriva patient out-of-pocket costs were between $30.01 and $50.00 in the second half of 2004. In the first half of 2005, 59% of Spiriva claims at United Healthcare were filled with an out-of-pocket cost of between $15.01 and $30.00.
About the Audits
The Managed Care Formulary Drug Audit is a semiannual study that monitors formulary status, reimbursement levels and prescribing guidelines for more than 1,000 drugs in 46 therapeutic classes, as reported by the largest, most influential managed care organizations in the United States. The spring 2005 pharmacy executive panel represented an estimated 57% of all U.S. HMO subscribers whose prescription benefits are controlled by formularies.
Verispan’s Vector One: Payer provides projected market share at the individual third-party payer level. In addition, this product analyzes patient payment and drug switching at the individual payer level. The patient dimension of Vector One: Payer identifies patients new to therapy, continuing on therapy or switches/additions.
For more information on the Managed Care Formulary Drug Audit or Vector One: Payer, or any other Verispan managed care product, please contact Betty Sanna or Nicholas Carras at (800) 982-5613; e-mail: elizabeth.sanna@verispan.com or nicholas.carras@verispan.com.
About Verispan
Verispan, a healthcare informatics joint venture of Quintiles Transnational Corp. and McKesson Corp., provides a broad array of information products and services to the healthcare industry, including sales targeting and compensation products; market research audits; healthcare profiles; comprehensive managed care offerings; primary market research; opinion leader mapping; data integration, warehousing and mining; data analysis and consulting; direct mail; list services; disease management studies; clinical trial investigator targeting and protocol recruitment evaluation; healthcare outcomes; and cost/benefit analyses, among many others. Verispan is also the nation’s leading provider of patient-centric longitudinal data, with dozens of products used by clients spanning the industry.
Headquartered in Yardley, Pa., Verispan employs over 500 dedicated healthcare information professionals. The company’s Web site is www.verispan.com.