Physicians and MCOs Believe Accountable Care Organizations Could Generate Savings of at Least 12 Percent in Asthma and COPD

BURLINGTON, Mass., July 10, 2013 /PRNewswire/ -- Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that both managed care organization (MCO) pharmacy directors and pulmonologists believe that accountable care organizations (ACOs) can result in medical and drug costs savings of at least 12 percent in asthma and COPD, highlighting the potential impact of ACOs on the market.

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The U.S. Physician & Payer Forum report entitled Accountable Care Organizations: How Will Payer and Provider Adoption of This Model Impact Prescribing Trends in Asthma and COPD? finds that pulmonologists currently participating in or expecting to soon join an ACO anticipate ACOs can (on average) reduce drug costs by 12 percent and medical costs by 13 percent for asthma/COPD, while MCO pharmacy directors/medical directors project savings of nearly 15 percent. These savings will result from ACOs' focus on prescribing lower-cost therapies, patient screenings and drug adherence. To accomplish this, MCOs' contracts with ACOs will tie compensation to physicians meeting metrics that improve outcomes and reduce costs – the underlying goals of ACOs.

ACOs will promote generic therapies, but their focus on medical costs and reducing hospitalizations will play a larger role on prescribing decisions. Nevertheless, branded therapies must distinguish themselves or risk losing patient share. For instance, 43 percent of pulmonologists indicated they would prescribe Merck's Dulera to fewer of their patients because they participate in an ACO. In comparison, GlaxoSmithKline's Advair faces a less challenging environment because some stakeholders perceive its active ingredient as more effective for moderate to severe asthmatics.

The report also finds that ACOs do not have distinct formularies but likely will in the next three years. Only 13 percent of the pulmonologists surveyed who currently participate in an ACO reported a distinct ACO formulary, driven by the shortage of lives within the ACO. These physicians—which currently serve on average 10,000 patients in their ACO (which they expect to increase to 17,000 in one year)—estimated they would need 30,000 members to justify their own formulary. Similarly, 72 percent of MCO pharmacy directors foresee their ACOs will develop their own formularies distinct from the MCO formulary within three years.

"Clearly, the distinct ACO formulary is coming. Drug marketers must identify and negotiate with those ACOs that have their own drug lists or they risk losing patient share to other branded therapies and generics," said Decision Resources Senior Director Roy Moore. "Drug marketers must adapt to this issue now or lose out to competitors."

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SOURCE Decision Resources