Acute Coronary Syndrome | Access and Reimbursement | Accountable Care Organizations | US | 2017
Introduction: This research explores the reimbursement and utilization landscape for acute coronary syndrome (ACS) drugs and the impact of accountable care organizations (ACOs) on payers’ and cardiologists’ decision-making. ACOs are provider organizations that manage the full continuum of care and take accountability for the total costs and quality of care for a defined patient population. ACS is a condition whose treatment can benefit from the integrated, patient-centered, evidence-based care practiced within ACOs and for which the goal of cost-effective treatment can influence prescribing.
Questions Answered in This Report:
- Generic clopidogrel dominates antiplatelet treatment of ACS, but Brilinta’s superior clinical profile has helped it gain patient share despite its higher price and greater restrictions. How is prescribing different for ACS in the ACO environment? How do cardiologists regard the various agents? How do MCO restrictions affect utilization?
- Two relatively new PCSK9 inhibitors—Repatha and Praluent—will probably have their labels expanded to secondary prevention of ACS. What is their use currently in this indication? How are MCOs likely to cover these drugs for this indication? Which of them is likely to have an advantage?
- ACOs are expected to take on more risk in terms of the medical and pharmacy costs of their patients. What formularies do ACO physicians commonly use for ACS patients? When do MCOs expect to require ACOs to take on risk? How many ACOs have their own dedicated formularies?
Scope:
- Markets covered: United States.
- Methodology: Surveys of 100 cardiologists and 30 managed care organization (MCO) officials, including 14 pharmacy directors and 16 medical directors, in January 2017.
- Indication coverage: Acute coronary syndrome (ACS).
- Key Drugs covered: Brilinta, clopidogrel, Effient, Plavix, Praluent, Repatha, Vascepa, Zontivity.
- Key companies mentioned: Amgen, AstraZeneca, Eli Lilly, Merck, Sanofi.
Related Market Assessment Reports
Report
Scleroderma (Systemic Sclerosis) – Current Treatment – Treatment Algorithms: Claims Data Analysis – Scleroderma (Systemic Sclerosis) (US)
Scleroderma (systemic sclerosis) (SSc) is a rare progressive autoimmune disorder characterized by skin fibrosis, systemic inflammation, and vasculopathy that can manifest as Raynaud’s phenomenon…
Report
Hypertrophic Cardiomyopathy – Current Treatment – Treatment Algorithms: Claims Data Analysis – Hypertrophic Cardiomyopathy (US)
HCM is a genetic heart condition characterized by thickened myocardium and left ventricular hypertrophy, often linked to sarcomere mutations. While some patients remain asymptomatic, common…
Report
Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia – Geographic Focus: China – Non-Hodgkin’s Lymphoma and Chronic Lymphocytic Leukemia – China In-Depth (China)
The NHL therapy market in China is poised for significant growth over the next decade, driven by the introduction of novel therapies and the continued uptake and label expansion of premium-priced…
Report
Non-Small-Cell Lung Cancer – Geographic Focus: China – China In-Depth – Non-Small-Cell Lung Cancer
Non-small-cell lung cancer (NSCLC) is the leading cause of cancer-related mortality in China. Treatment is based on biomarker status; patients with EGFR- and ALK-positive tumors generally receive…
Report
Irritable Bowel Syndrome – Current Treatment – Treatment Algorithms – Claims Data Analysis – IBS-Diarrhea (US)
Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by alterations in motility, stool consistency and frequency, and urgency. The disorder is grouped into three…
