Pm360 market watch: managed-care coverage still at the heart of cardiovascular market

PATIENT-CENTRIC ADHERENCE • CROWDSOURCING YOUR CAMPAIGNS • AVOID BRANDING DISSONANCE The Essential Resource for Pharma Marketers HOW ‘HOSPITAL' IS YOUR PRODUCT? THINK TANK Co-Promotions without Stress REVIVING THE DTC CHANNELUnbranded Packs a Punch TRENDSETTERR.J. Lewis of eHealthcare Solutions ‘Relationship' FEB cover 1.indd 1 2/1/12 1:03:38 PM 30-31 Market Watch.V1 1/31/12 9:32 PM Page 2 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 Melissa Leonhau Thypertension and cholesterol medications generics.
alone accounting for $34.5 billion in sales and Until April 2010, ARBs were without direct S irector, Strateg enior Manageric , Marketing 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 scriptions, respectively. 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 30 PM360 FEBRUARY 2012
DOWNLOAD FIGURES AT 30-31 Market Watch.V1 1/31/12 9:33 PM Page 3 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 COMBINATION PRODUCTS 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 hydrochlorothiazide. 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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