 SAMM --
June 2007
 In This Issue...
Introduction:
Amid the ever increasing competitive cholesterol lowering market recent aggressive
generic introductions have placed added burden on branded drugs to grow their
market share. In the inaugural release of Strategic Assessment of Managed
Markets, Decision Resources examines the relationship between a drug’s
formulary placement and level of access in each of the 50 largest US cities and ties this directly to the drug’s performance. In each city we examine the
five largest managed care organizations’ formulary tier structure and
prescribing limitations placed upon cholesterol lowering agents. In addition we
are introducing a truly unique and insightful examination of the prevalence of
dyslipidemia and the projected drug treatment rates for each of the 50 major
markets to identify areas of under-treatment and possible opportunities.
In this report we examine the impact of increasing generic competition following
Zocor’s loss of patent protection in 2006 and the managed care strategy within
the United States among the remaining branded products in the dyslipidemia
marketplace. In the statin drug class only two branded statins remain; Crestor
and Lipitor. Crestor is newer to the market and is generally considered more
powerful than Zocor or Lipitor, and as such is somewhat protected from the
launch of generic simvastatin. Crestor, therefore, is still in the growth phase
of its lifecycle. Lipitor, however, is the dominant statin in the market and is
expected to lose substantial share to generic simvastatin, placing Pfizer in
the role of protecting existing market share. Adjunct therapies like Zetia,
Welchol, and others are looking for opportunities to grow with statin usage,
and may look to target MSAs where particular statins are dominant. Fixed-dose
combinations of statins with these adjuncts are targeting patients often
already on one of the component medications, and may want to target MSAs where
that component drug is already overperforming.
For easy review we provide both an in-depth report that highlights the findings of our
research and three Excel-based dashboards organized for each city (MSA), health
plan, and branded drug. Each dashboard examines the dominant drivers of
performance such as formulary tier status, restrictions to access, co-pay for
generic, preferred brand and non-preferred brand. In addition, we examine the
plans spend level by generics and brand (preferred and non-preferred) and, in
the MSA dash, we provide prevalence numbers, drug-treated estimates, dominant
managed care forced-ranked by commercial Rx lives, and the formulary status for
major drugs prescribed to lower cholesterol.
This combined insight provides a unique examination of the dyslipidemia drug market
viewed through the filters of formulary access and MSA
prevalence to drug treated ratio to provide actionable avenues to
increase market share of marketed drugs or to plan the launch of a novel agent
into the dyslipidemia market.
Questions Answered In This Report:
Opportunities for overall market
growth: By looking at regional epidemiology data and regional treatment rates we identify the largest
opportunity areas within the United States.
What is dyslipidemia prevalence at the local level, and is it driven by age,
gender, race, or socioeconomic status? Which markets have the highest treatment
rates based on local prescription volumes of dyslipidemia drugs?
Formulary Control: Formulary data collected for the
top 5 commercial insurers among the top 50 MSAs informs comparative analysis of
how dyslipidemia brands are positioned within regional markets. Which markets are the most restrictive in terms of
plan-specific demand controls? What percent of patients access Lipitor at tier
2 versus Crestor? Which MSAs favor generic simvastatin over branded statins?
Which MCOs give Zetia favorable positioning over Vytorin, the fixed-dose combo
of this agent with simvastatin?
Market Dynamics: Strategic summarization and
organization of key managed care data metrics facilitates identification of
markets and plans of opportunity for key brands. In which markets should Kos contract for better formulary access? Where
should Abbott focus for more effective pull-through? Where should Pfizer use
copay coupons for Lipitor?
Includes:
- Eight key dyslipidemia brands: Advicor, Caduet, Crestor, Lipitor, Tricor, Vytorin, Welchol, Zetia
- Performance of competing generic drugs: Simvastatin, other generic statins, bile acid sequestrants, fibrates.
- Top 50 MSAs: Atlanta, Austin, Baltimore, Bergen, Boston, Charlotte, Chicago, Cincinnati, Cleveland, Columbus, Dallas, Denver, Detroit, Fort Lauderdale, Fort Worth,
Greensboro, Houston, Indianapolis, Kansas City, Las Vegas, Los Angeles,
Miami, Milwaukee, Minneapolis, Nashville, Nassau, New Haven, New Orleans,
New York, Newark, Norfolk, Oakland, Orange County, Orlando, Philadelphia,
Phoenix, Pittsburgh, Portland, Raleigh, Riverside, Sacramento, Salt Lake
City, San Antonio, San Diego, San Francisco, San Jose, Seattle, St. Louis,
Tampa, and Washington D.C.
- Top 20 health plans and formularies: Aetna, BCBS of Florida, BCBS of Massachusetts, BCBS of
Michigan, Blue Shield of California, CareFirst, CIGNA, Coventry, Harvard
Pilgrim, Health Care Service Corporation, Health Net, Highmark, Horizon
BCBS of New Jersey, Independence Blue Cross, Kaiser Foundation, Medica,
The Regence Group, Tufts Associated Health Plans, UnitedHealth Group, and WellPoint.
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