 Physician & Payer Forum --
July 2008
 In This Issue...
In 2007, agents prescribed to treat the symptoms of
Alzheimer’s disease (AD) alone (excluding use for other forms of dementia) achieved
more than $1.7 billion in ex-manufacturer sales in the United States alone. Market leaders, Eisai/Pfizer’s Aricept (donepezil), and Forest Pharmaceutical’s
Namenda (memantine) achieved $912 and $500 million in U.S. ex-manufacturer sales for the treatment of AD, respectively, 2007. In December 2008,
this market will undergo major upheaval when Razadyne (galantamine) becomes the
first acetylcholinesterase inhibitor (AChEI) to lose market exclusivity in the United States. In 2011, the landscape will shift again as the first disease-modifying
agents are launched, followed by imaging agents capable of detecting AD at
earlier stages of the disease.
Decision Resources’ Physician and Payer Forum report,
"The Impact of Razadyne’s
Genericization and the Launch of Biologic Disease-Modifying Drugs on the
Alzheimer’s Disease Market: Clinician and Payer Receptivity to Novel Agents" explores the impact of these disruptions. We surveyed 72 U.S. PCPs, 71
neurologists, and 20 managed care organization (MCO) pharmacy directors and
compared their responses to assess similarities and differences. This survey
enabled Decision Resources to achieve the following:
- Understand which brands will be hit, and which are best
insulated from the entry of generic galantamine. Will there be unexpected
winners?
- Understand variations in treatment rates for AD and other
dementias, by disease severity, and clinician specialty. How will the
availability of generic galantamine treatment rates, and will it
engender earlier treatment or longer courses of therapy? Will it encourage
wider use of combination therapy?
- Explore clinicians’ attitudes toward treating mild AD. What
are the factors that currently limit prescriptions for mild AD?
- Determine how clinicians perceive the relative efficacy
and tolerability of available agents and classes. Do clinicians consider
that AChEIs have differential efficacy? How do they rank them? How does
formulary coverage of the AChEIs impact clinician choice?
- Uncover alignments and misalignments in the attitudes and
behaviors of clinicians versus MCO pharmacy
directors in factors that will influence the uptake of disease-modifying therapies. What is the
magnitude of impact on cognitive decline that would make PCPs and neurologists
prescribe a novel agent? That would make pharmacy directors reimburse a
novel agent? Do clinicians prefer oral or IV agents?
- Analyze the current formulary tier assignments of agents
used to treat AD based on plan type (including Medicare PDP and private plans), and review the
level of copayments associated with each tier and the cost controls
imposed by agent and plan type.
- Understand the factors influencing formulary inclusion,
and analyze the future tier assignments of emerging agents fulfilling hypothetical
profiles.
- Explore clinician and payer attitudes to emerging
diagnostics. Will clinicians refer patients? Will payers pay?
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