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Physician Views: US formulary management in diabetes – are endocrinologists impressed?

Published by FirstWord Pharma: 12 Aug 2014 | 145 | In Stock

Introduction

Scope



Pricing pressure exerted by US pharmacy benefit managers (PBMs) and managed care organisations (MCOs) within the 'oral' and insulin diabetes markets intensified this year and looks set to retain momentum over the next few years, according to analysts and industry commentators – see Spotlight On: Pharma watch out! – US formulary exclusions expected to increase in 2015.


Characterised by an increasing number of relatively undifferentiated products within each of the main drug classes, the diabetes segment is ripe for payers to negotiate greater discounts in exchange for preferred formulary status and threat of exclusion from preferred formulary listings.


The decision by Express Scripts to continue excluding Novo Nordisk's recognised best-in-class GLP-1 agonist Victoza (in favour of AstraZeneca's Bydureon) demonstrates a certain level of aggressiveness on the part of PBMs, and an intensification of efforts could manifest itself over the next few years.


In addition to limiting preferred formulary coverage to one or two products within each of the oral and insulin classes, payers are increasingly reluctant to allow patients to 'cycle' through the various oral drug classes subsequent to receiving metformin therapy and prior to progression to insulin, argued Bernstein analyst Ronny Gal recently. Inter-class switching is becoming more frequent as a result claims the analyst, who cites that two-thirds of patients who switched from Victoza as a result of its exclusion did so to a product in a different class (either a DPP-4 inhibitor or SGLT-2 inhibitor).


Puchase Reasons


In light of the expectation that pricing pressure in the US diabetes market will intensify – therefore increasing the necessity for some patients to switch therapies – we are polling US-based endocrinologists to gauge their opinion towards this trend. Specifically we are asking them...


  • Their opinion towards the notion that payers may look to limit patient access to one 'oral' diabetes drug class subsequent to treatment with metformin and prior to insulin therapy?

  • Which of the 'oral' diabetes drug classes they would like to see the broadest/preferential access for?

  • Whether the decision to exclude Novo Nordisk's GLP-1 agonist Victoza (liraglutide) from Express Scripts' preferred formulary in favour of AstraZeneca's Bydureon (exenatide) in 2014 was an acceptable one based on the clinical profiles of the two products?

  • How they would describe the typical patient resistance levels to inter-class brand switching within the DPP-4 inhibitor and SGLT-2 inhibitor classes?

  • Their opinion towards the future selection (once approved) of a biosimilar insulin as the preferred product in the basal insulin category?
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