Formulary Advantages in Dyslipidemia: Will outcomes data dominate the reimbursement landscape for dyslipidemia?
The significant impact of cardiovascular disease on human morbidity and mortality alongside the proven efficacy of many lipid-modifying therapies drives both the aggressive treatment of dyslipidemia by physicians and the generous reimbursement of therapies among U.S. health plans. Some branded therapies continue to receive generous reimbursement from health plans despite the availability of in-class generics because they possess highly valued qualities or capabilities such as improved risk reduction, higher potency or better tolerability. A number of upcoming events may reshape the reimbursement landscape for dyslipidemia including generic entry of Pfizer's blockbuster statin, Lipitor (atorvastatin), in 2012 and the likely emergence of two first-in class therapies, Genzyme/Isis' mipomersen and Roche's dalcetrapib. Using tiering and restrictions data from Fingertip Formulary, as well as insight from 50 pharmacy directors, this report determines the key trends in reimbursement of therapies for dyslipidemia, drivers of these trends, and how stakeholders can capitalize on future shifts in coverage to steal share from the competition.
