U.S. Health Plans Will Increasingly Look at Cardiovascular Outcomes When Determining Formulary Status of Emerging Therapie

Pharmacy Directors Report Using Incentives Other Than Tier Placement and Lack of Restrictions to Encourage Early Line Use of Generics for Dyslipidemia Treatments, According to a New Report from HealthLeaders-InterStudy and Fingertip Formulary

NASHVILLE, Tenn. and GLEN ROCK, N.J.--(BUSINESS WIRE)-- HealthLeaders-InterStudy and Fingertip Formulary find that U.S. health plans will increasingly look at cardiovascular outcomes when determining formulary status of emerging therapies for dyslipidemia. According to the recent Formulary Forum report entitled Formulary Advantages in Dyslipidemia: Will Outcomes Data Dominate the Reimbursement Landscape for Dyslipidemia?, clinical trials have demonstrated that a therapy’s ability to correct abnormal lipid levels does not necessarily result in improved cardiovascular outcomes.

As a result, the U.S. Food and Drug Administration (FDA) will increasingly require emerging therapies for dyslipidemia to provide outcomes data with their new drug application. Fifty-six percent of surveyed pharmacy directors expect their plans will compare outcomes data across dyslipidemia treatments to determine tier placement and formulary restrictions. Among both private and Medicare plans, AstraZeneca’s Crestor and Pfizer’s Lipitor receive substantially higher rates of preferential reimbursement compared with Novartis’ Lescol and Kowa’s Livalo due to the abundance of available outcomes data.

The report also finds that 48 percent of pharmacy directors report using incentives to encourage physicians and patients to use generics over branded therapies for dyslipidemia. Survey respondents indicate that physicians receive monetary incentives, rate increases and year end bonuses based on their generic versus brand prescription fill rate. Incentives for patients include reducing patient cost-sharing by either eliminating or minimizing copays.

“Incentives serve to limit early line use of branded therapies for dyslipidemia, but the effects are tempered by the fact that many physicians would choose to initiate therapy with a generic when appropriate, regardless of these incentives,” states Leigh Compton, M.D., Ph.D, author of this report. “That being said, pharmaceutical companies should consider copay assistance programs, where legal, to diminish a patient’s increased cost burden associated with using branded dyslipidemia therapies over generics.”

The new Formulary Forum report is based on a survey of 50 U.S. pharmacy directors who control formularies at national, regional and state-level managed care organizations, as well as historical formulary data from Fingertip Formulary.

About Fingertip Formulary

Fingertip Formulary (www.FingertipFormulary.com), the leading provider of access to and insight into formulary data in the United States, offers comprehensive formulary data covering commercial, Medicaid, Medicare and PBM plans, among others. Fingertip Formulary is a Decision Resources, Inc. company.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.

About Decision Resources, Inc.

Decision Resources, Inc. 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. Both HealthLeaders-InterStudy and Fingertip Formulary are Decision Resources, Inc. companies. Please visit Decision Resources, Inc. at www.DecisionResourcesInc.com.

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Erin O’Leary, 781-993-2641
[email protected]
Decision Resources, Inc.
Elizabeth Marshall, 781-993-2563
[email protected]

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