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Survey: ACOs Create Challenges for Branded Acute Coronary Syndrome and Atrial Fibrillation Drugs

Products that improve hospital-based outcomes have advantages in securing preferred drug status

Decision Resources Group, a health care research firm located in Burlington, Mass., finds that managed care organizations (MCOs) and cardiologists alike believe accountable care organizations (ACOs) will reduce costs and improve outcomes for patients with acute coronary syndrome (ACS) and atrial fibrillation (AF).

A survey of 100 non-interventional cardiologists and 42 MCO pharmacy and medical directors found that ACOs are driving up generic drug prescribing for ACS and AF. However, ACOs also place high value on positive hospital-related outcomes, providing an opportunity for drug marketers to highlight clinical aspects of branded therapies that increase compliance and that reduce cardiac complications leading to hospital readmissions.

The report also found that cardiologists as well as MCO pharmacy and medical directors anticipate medical and drug cost savings of up to 21% for ACS and AF. Moreover, more than two-thirds of surveyed cardiologists said they were paying more attention to cost-effectiveness data since joining their ACOs.

“Most MCOs and surveyed cardiologists participate in ACOs or plan to do so by 2015, and they expect these organizations to take on more of the financial risk — including prescription drugs — for the health of their assigned patient populations,” said analyst Chris Lewis. “Given that MCOs expect more ACOs to eventually develop separate drug formularies, it behooves drug marketers to start laying the groundwork for preferred product placement, including homing in on the clinical advantages that enhance compliance and keep patients out of the hospital.”

Most of the surveyed cardiologists and MCO directors cited reductions in preventable hospitalizations and increased prescribing of generic drugs as key outcomes achieved by ACOs. These metrics were among the most likely to be tied to provider compensation in an ACO.

As a result of the focus on drug costs, a majority of MCO pharmacy and medical directors said physicians are prescribing generic drugs to a greater percentage of beneficiaries or will do so in 12 months.

“ACOs drive prescribing to generics that are market mainstays, most often clopidogrel for ACS and warfarin for AF,” Lewis said. “Otherwise, our survey indicates that ACOs neither discourage nor encourage other specific treatments for ACS and AF.”

Source: Decision Resources; May 21, 2014.

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