Pm360 market watch: managed-care coverage still at the heart of cardiovascular market
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MANAGED-CARE COVERAGE STILL AT THE HEARTOF CARDIOVASCULAR MARKET
BY MELISSA LEONHAUSER
he market of products that treat cardio-
off balance? Most ARBs are brands; the other
vascular conditions is massive, with
classes are dominated by much less expensive
Thypertension and cholesterol medications generics.
alone accounting for $34.5 billion in sales and
Until April 2010, ARBs were without direct
S irector, Strateg
Marketing, at SDI.
Communications, at IMS
almost 19% of all pharmaceutical prescriptions
competition from generics. That month, losartan
She can be reached at
Health. She can be reached at
during the 12 months ending November 2011.
and losartan HCTZ, generic versions of Cozaar
Hypertension is the top condition seen and
and Hyzaar, became available. For years before
treated by office-based physicians each year.
that, Novartis' Diovan and Diovan HCT ranked
Several different types of medications are used
first in ARB prescriptions month after month
either alone or together to treat hypertension.
because of strategic and successful managed-care
The most popular class of drugs is angiotensin-
contracting and significant investments in promotion.
converting enzyme (ACE) inhibitors, which
Novartis' strategy included contracting with
Email our strategicmarketing expert for
accounted for 30% of the hypertension market's
managed-care plans to place Diovan on tier two
541 million prescriptions in the 12 months end-
of their benefit designs (the preferred tier for
ing November 2011. Following ACE inhibitors
brands) with only one or two other ARBs.
were beta-blockers and calcium channel block-
After securing these types of contracts,
ers (CCB) with 24% and 18% of market pre-
Novartis then promoted Diovan's preferred status
and lower patient co-pays to physicians. In aclass with little perceived product differentiation,
lower co-pays and little payer issues at the
The fourth-most popular type of hypertension
pharmacy made Diovan an attractive option for
therapy, angiotensin receptor blockers (ARBs)
and drugs that combine an ARB with a generically
These contracts were positive for managed-care
available CCB or other type of antihypertensive,
plans; Diovan held significant market share and
accounted for 15% of market prescriptions—but
accounted for high prescription volumes,
a staggering 53% of sales in the year ending
motivating payers to continue to contract similarly
November 2011. Why are the market shares so
with Novartis. Diovan benefited because the
FIGURE 1 HYPERTENSION MARKET PERFORMANCE 12 months ending November 2011
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FIGURE 2 SHARE OF TOTAL ARB PRESCRIPTIONS
months ending November 2011, the average patient
out-of-pocket cost for a Diovan/Diovan HCT prescriptionwas $35.22. In Medicare Part D, it was $29.99. Theout-of-pocket cost for Diovan was the lowest of thebranded ARBs. Benicar/Benicar HCT's average out-of-pocketcost was $40.
Interestingly, although Diovan is more expensive than
losartan, the percentage of submitted prescription claimsthat are not paid—either because the patient or payerrejects them—is comparable. In the year ending November2011, 92% of submitted prescription claims for both Diovanand losartan were paid. Patients rejected 3.2% of Diovanprescriptions; payers rejected 4.7%. For losartan, patientsrejected 3.4% and payers rejected 4.5% of submittedprescriptions. With cost the most common reason whypatients reject a prescription, it is extremely positive forDiovan that its rejection rate isn't higher than that for thegeneric. Benicar didn't perform as well, with 3.9% of pre-scriptions rejected by patients and 6.4% rejected by payers.
Rejected claims cause problems beyond just the original
lost business. In many cases, if a prescription is rejected,the pharmacy will try to replace the prescription by reachingout to the patient and physician. If physicians repeatedly
contracted limit to the number of ARBs that could share
are contacted over the same drug being rejected, they likely
tier-two status stifled the growth of other brands.
will decrease their prescribing of that medication.
Benicar/Benicar HCT has made some inroads with managed-care plans and physicians, but has not yet approached
Diovan's prescription volumes.
Manufacturers know that in the cardiovascular market,
In May 2011, more than a year after losartan/losartan
cost and managed-care coverage can drive success. And,
HCTZ became available, prescriptions for the generics
with concomitant drug usage across different classes,
exceeded Diovan/Diovan HCT prescriptions for the first
combination products are a way for manufacturers to get
time. Most recently, in November 2011, losartan/losartan
more mileage from their brands before generic equivalents
HCTZ accounted for 38% of ARB prescriptions.
surface. Most ARB combination products join a branded
Diovan/Diovan HCT accounted for 31% and Benicar/Benicar
ARB with amlodipine, the generic equivalent of the calcium
HCT for 12%.
blocker Norvasc. The most successful of these combination
Initially, the shift to losartan happened at the pharmacy,
products are Exforge and Exforge HCT, which join
as patients taking Cozaar and Hyzaar were easily switched
amlodipine and Diovan or amlodipine with Diovan and
from branded to generic therapies. More recently, the
change is happening at physicians' offices. New patients
In November 2011, Exforge/Exforge HCT accounted for 4%
are being prescribed losartan/losartan HCTZ more than
of ARB market prescriptions. In addition to the patient
any other ARB. In November 2011, 57% of prescriptions for
benefit of fewer pills to take each day, Exforge is cheaper
new-to-market patients were for losartan/losartan HCTZ.
than individual prescriptions for the ingredient drugs. In
Diovan/Diovan HCT followed with just under 20%.
the year ending November 2011, the average out-of-pocketcost for an Exforge prescription was $37.61. The combined
cost of generic amlodipine ($7.66) and Diovan ($35.22) was
With generic competition, managed-care coverage and
over $5 more at $42.88.
reasonable patient costs are more important for brands
In order for the remaining brands and combination
than ever before. As a generic, losartan/losartan HCTZ has
products in the ARB market to continue to compete,
the best managed-care coverage and lowest patient
they must maintain good managed-care coverage and
co-pays. In the year ending November 2011, the average
marketing budgets sufficient to remind physicians of
patient out-of-pocket cost for a losartan/losartan HCTZ
reasonable patient co-pays. Given the perception that
prescription was $12.09.
drugs in this market are very similar, brands are at
Diovan/Diovan HCT still enjoys solid managed-care
great risk of being replaced by the generically available
coverage, especially in Medicare Part D plans. In the 12
Reprinted from PM360, The Essential Resource for Pharma Marketers, February 2012 Issue. Copyright 2011 by AMS Group, LLC. All Rights Reserved.
FEBRUARY 2012 PM360 31
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