Boehringer faces uphill battle for Stiolto, thanks to payer arm-twisting

Boehringer Ingelheim's respiratory sales have taken a beating lately as competitors in the space vie for formulary positioning. And even with a new combo approval in the mix, that may not change.

Boehringer's Allan Hillgrove

The German pharma recently won FDA approval for Stiolto Respimat, a LAMA/LABA combination that pairs tiotropium--the active ingredient in the company's Spiriva Respimat--and olodaterol--the active ingredient in its Striverdi Respimat--for the treatment of COPD. And as Allan Hillgrove, who heads Boehringer's pharma marketing and sales, acknowledged to EP Vantage, pricing might be tough for the dual-acting treatment.

"U.S. payers have become increasingly willing to use price as a lever," he told the publication.

The respiratory field has seen evidence of that most clearly with GlaxoSmithKline's ($GSK) aged Advair, which--despite the lack of a substitutable generic in the U.S.--has recently seen its stateside sales tumble. In 2014, leading pharmacy benefits manager Express Scripts ($ESRX) excluded the med from its national preferred formulary, helping trigger a 25% crash in its U.S. sales for the year.

Through some aggressive discounting, Glaxo was able to get the treatment picked up once again by Express Scripts for 2015, and fellow payer CVS ($CVS) even knocked AstraZeneca's ($AZN) rival Symbicort off its 2015 "covered" list. But that discounting took a toll on sales, too; Advair's U.S. top-line haul shrank 9% in this year's Q1.

It's that kind of pressure that's been plaguing Spiriva, whose sales fell 8.1% to €3.3 billion ($3.5 billion) last year, EP Vantage notes. And GSK will be the first to say things haven't gone the way it expected for its own LAMA/LABA combo, Anoro. The blockbuster hopeful has well underperformed analyst expectations since its launch last April, pulling in just £14 million ($21 million) last year. One big reason is access: While Glaxo chief Andrew Witty says things are finally improving, last summer, Anoro boasted just 30% Medicare Part D coverage.

That doesn't bode well for Boehringer, which is relying on Stiolto to help its respiratory business return to moderate growth this year. Unlike respiratory top-dogs GSK and AstraZeneca, it's not pushing further into combo territory, either.

"We are not ... developing a triple combination for the time being," Barner told EP.

And there could be more competition on the scene for Stiolto before the year is out. Novartis ($NVS) is currently awaiting an FDA decision on its Ultibro Breezhaler--already on the market in Europe--and it expects to hear back in the second half of 2015.

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