Here's an example of harmonic convergence in pharma marketing. Insurance giant Cigna inked a deal with AstraZeneca to allow its brand-name statin drug Crestor to be prescribed without prior authorization--provided a computer model says a patient needs it.
It's a win for AstraZeneca ($AZN), which needs to spin as much gold out of Crestor before it falls off patent in 2016--and has to compete with a slew of generic statin meds in the meantime. That includes the behemoth Pfizer ($PFE) drug Lipitor, with copies available from a number of generics makers--and with some aggressive discount-based marketing for the brand itself. Crestor's 2013 sales were down 9% year over year, though it remained one of the 10 best-selling drugs in the industry.
It's a win for Cigna, the insurer says, because it will help reduce drug costs. It's a win for Big Data-based decisionmaking in healthcare. And it's a win for payer-focused marketing, as increasingly price-conscious insurers and PBMs gain greater sway over prescribing decisions.
The linchpin of the arrangement is Cigna's "predictive modeling," which uses medical and pharmacy data to identify patients most at risk for atherosclerosis. To Cigna--and AstraZeneca--that means they're most in need of Crestor, which is considered a high-powered alternative to other statins. Patients flagged by the model won't need to follow the old "step therapy" rule, which requires trying other, cheaper drugs first. They can move directly to Crestor.
Cigna is bragging that the program is the first of its kind, and that predictive modeling is "a more effective way" to manage drug spending. In this case, Cigna will spend more on patients who need the higher-priced alternative, and others who don't will be well served by cheap generics, the company said.
AstraZeneca backed up Cigna's claim to pioneering status. "Predictive risk modeling can be used to help support the right treatment for the right patient at the right time, and we are excited to be working with Cigna because they are the only insurance carrier or pharmacy benefit manager we have seen who has offered this capability," said Dr. Philip de Vane, AstraZeneca's executive director of U.S. medical affairs.
The upshot for AstraZeneca? Crestor will be Cigna's preferred brand-name statin, which means lower copays, as long as patients are either deemed high risk to start with or don't get adequate results from a generic statin.
Cigna's vote of confidence also hints that new cholesterol-fighting guidelines proposed by the American College of Cardiology may actually end up benefiting Crestor as analysts predict. The guidelines ID a new high-risk class of patients--similar, no doubt, to Cigna's high-risk group--that could benefit from the drug. And with AstraZeneca on the hook for promises made to defend itself from a Pfizer takeover, the U.K. company can use as much of a Crestor boost as it can get.
- read the press release from Cigna and AZ
Special Reports: The 10 best-selling drugs of 2013 - Crestor | Top 10 pharma companies by 2013 revenue - AstraZeneca