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
Bladder Cancer and Upper Tract Urothelial Carcinoma – Geographic Focus: China – Bladder Cancer and Upper Tract Urothelial Carcinoma – China In-Depth – China
China’s bladder cancer market is entering a period of accelerated expansion, as novel branded therapies reshape systemic management. A major growth driver is the expanding role of immune…
Report
Major Depressive Disorder (DSM-V) – Current Treatment – Treatment Algorithms: Claims Data Analysis – Major Depressive Disorder (US)
Major depressive disorder (MDD) is a widely drug-treated condition managed with multiple drug classes, most commonly selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine…
Report
Dry and Wet Age-Related Macular Degeneration – Access & Reimbursement – Access & Reimbursement – Age-Related Macular Degeneration (US)
The U.S. wet AMD market is led by intravitreal therapies such as Eylea, Eylea HD, and Vabysmo, alongside the continued off-label use of compounded Avastin, driven by cost considerations. In…
Report
Psoriatic Arthritis – Current Treatment – Treatment Algorithms: Claims Data Analysis – Psoriatic Arthritis (US)
Treatment of psoriatic arthritis (PsA) typically begins with conventional disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, and progresses to more potent biologics and/or…
