Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, finds that U.S. physicians are eager to prescribe GlaxoSmithKline/Theravance’s Relovair, which is expected to be the first and only once-daily long-acting beta2 agonist/inhaled corticosteroid (LABA/ICS) fixed-dose combination to enter the U.S. market for the treatment of both asthma and chronic obstructive pulmonary disease (COPD). Although surveyed physicians view once-daily dosing as Relovair’s most desirable attribute, access to the therapy will be an important determinant of the drug’s use as over 90 percent of surveyed U.S. pulmonologists and primary care physicians (PCPs) indicate that they will prescribe the drug if it is on a preferred tier (tier 1 or 2) but only about one-third of surveyed physicians will prescribe Relovair if it is on a nonpreferred tier (tier 3 or higher). These findings suggest that, in the opinions of prescribers, improvements in dosing will not outweigh additional out-of-pocket costs to the patient.
The new U.S. Physician & Payer Forum report entitled U.S. Physician and Payer Attitudes to Novel and Me-Too Fixed Dose Combination Inhalers for Asthma and Chronic Obstructive Pulmonary Disease also finds that surveyed managed care organization (MCO) pharmacy directors would be persuaded to grant Relovair preferred brand status if the drug demonstrates improvements in efficacy relative to currently marketed LABA/ICS fixed-dose combinations. In the absence of any gains in efficacy, the majority of surveyed MCO pharmacy directors would place Relovair on a preferred tier if it is priced at less than a 10 percent premium to GlaxoSmithKline’s Advair, but just 28 percent of MCOs would do the same if the drug is priced at a greater than 10 percent premium to Advair.
“Given that pharmacy directors do not appear to be willing to tolerate a greater than 10 percent price premium relative to Advair without gains in efficacy, Relovair will need to be priced competitively to achieve widespread preferred brand status,” said Decision Resources Analyst Amanda Puffer. “However, regardless of whether Relovair achieves widespread preferred tier status, physicians indicate fewer of their patients will be treated with Advair and AstraZeneca’s Symbicort following the launch of Relovair.”
The report also finds that surveyed physicians do not prescribe Merck’s Dulera for asthma because of lack of reimbursement for the drug or the implementation of cost controls. When provided with a profile of Dulera for COPD that included key Phase III clinical trial data, physicians said they would be most inclined to prescribe Dulera if it were available at a lower cost than Advair, highlighting the fact that there is little to differentiate the drug from currently available LABA/ICS fixed-dose combinations.
Forty percent of surveyed MCOs exclude Dulera from their largest commercial plan, while 60 percent of surveyed MCOs exclude Dulera from their largest Medicare prescription drug plan. Additionally, nearly one-third of surveyed MCOs expect to move Advair to a more favorable tier in the next 12 months, and 35 percent expect to either move Dulera to a less favorable tier or remove it from their formulary. These changes in tier placement could intensify current trends that promote access to Advair and restrict access to Dulera.
The report also finds that among the four novel LABA/long-acting muscarinic antagonist (LAMA) fixed-dose combinations included in the survey—Forest/Almirall’s formoterol/aclidinium, Boehringer Ingelheim’s olodaterol/tiotropium, Novartis’s indacaterol/glycopyrronium and GlaxoSmithKline/Theravance’s vilanterol/GSK-573719—the greatest percentage of surveyed pulmonologists and primary care physicians selected vilanterol/GSK-5783719 as the most promising LABA/LAMA.
About Decision Resources
Decision Resources (www.decisionresources.com) is a world leader in market research publications, advisory services and consulting designed to help clients shape strategy, allocate resources and master their chosen markets. Decision Resources is a Decision Resources Group company.
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Last updated on: 11/04/2012