Medicare beneficiaries with chronic obstructive pulmonary disease (COPD) have access to more than a dozen long-acting bronchodilator inhalers, ranging from blockbusters like GlaxoSmithKline’s (GSK’s) Advair, AstraZeneca’s Symbicort, and Boehringer Ingelheim’s Spiriva to newer combination inhalers such as GSK’s Anoro Ellipta and Trelegy Ellipta (the first triple combination) and Boehringer Ingelheim’s Stiolto Respimat. Despite the competition, the cost of inhalers remains high, about $400-500 a month, presenting an affordability challenge particularly for seniors in high-deductible Medicare Advantage plans. Amid the recent entry of generic salmeterol / fluticasone, the COPD market is still developing as new products seek to improve efficacy, as well as dosing convenience. This report examines the reimbursement and prescribing environment for current and select emerging COPD drugs, with a special focus on patient affordability of inhalers in Medicare Advantage plans with prescription drug coverage (MAPD).
Geography: United States
Primary research: Surveys of 100 U.S. pulmonologists and 41 U.S. MCO pharmacy and medical directors
Fingertip formulary: Formulary coverage data of COPD therapies by Medicare Advantage prescription drug plans covering 14.8 million lives nationally.
Key drugs covered: Advair, Symbicort, Dulera, Breo, AirDuo, Spiriva, Tudorza, Incruse, Seebri, Anoro, Stiolto, Bevespi, Utibron, Dualir, Trelegy, Breztri
Reimbursement and contracting
Access and prescribing
Opportunities and challenges for emerging therapies
Disease-specific special topic
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.