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.