Most Surveyed MCOs Intend to Cover Amgen's Prolia for Osteoporosis When it is Launched in the U.S., but 28 Percent Do Not Know How They Will Tier the Agent

September 9, 2009

Price Will Not Substantially Alter Prolia's Tiering Status but Will Affect Availability, According to a New Report from HealthLeaders-InterStudy and Fingertip Formulary

NASHVILLE, Tenn. and GLEN ROCK, N.J., Sept. 9 /PRNewswire/ -- HealthLeaders-InterStudy and Fingertip Formulary find that 90 percent of surveyed pharmacy directors intend to reimburse Amgen's Prolia when the injectable treatment for osteoporosis is launched in 2010. However, according to the new Formulary Forum report entitled Formulary Advantages in Osteoporosis: Rise and Fall of Access in the Wake of Fosamax Generics, Rebate and Contracting Efforts, and New Drug Launches, more than a quarter (28%) of those surveyed say they do not know how their managed care organization will tier Prolia.

When looking at the impact of price on tier status, if Prolia is priced at a ten percent discount relative to Eli Lilly's Forteo, only 12 percent of surveyed pharmacy directors say their managed care organizations' commercial plan would reimburse the drug on Tier 1 or Tier 2. At the same price point on their Medicare plans, surveyed pharmacy directors are evenly split as to whether they would reimburse Prolia as a Tier 3 or 4 benefit, but 34 percent of surveyed pharmacy directors say their managed care organization would not include Prolia on their Medicare formularies at this price.

"Forteo is most commonly covered as a Tier 2 benefit on commercial plans and on Tier 4 (or higher) on Medicare plans, so our survey findings suggest Prolia will have disadvantaged status compared with its next closest competitor," said Michael Malecki, Ph.D., product manager for Formulary Forum. "New classes of agents are typically reimbursed, but more surveyed pharmacy directors say they would not add Prolia to their commercial and Medicare formularies if it is priced equal to or above the net price of Forteo, indicating managed care organizations may shy away from novel therapies for this indication if they are priced at a premium."

The new Formulary Forum report is based on a survey of 50 U.S. pharmacy directors who control formularies at national, regional and state-level managed care organizations, as well as historical formulary data from Fingertip Formulary.

About Fingertip Formulary

Fingertip Formulary (www.FingertipFormulary.com), the leading provider of access to and insight into formulary data in the United States, offers comprehensive formulary data covering commercial, Medicaid, Medicare and PBM plans, among others. Fingertip Formulary is a Decision Resources, Inc. company.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Both HealthLeaders-InterStudy and Fingertip Formulary are Decision Resources, Inc. companies. Please visit Decision Resources, Inc. at www.DecisionResourcesInc.com.

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

    For more information, contact:

    Lisa Osgood                            Elizabeth Marshall
    HealthLeaders-InterStudy               Decision Resources, Inc.
    781-296-2606                           781-296-2563
    losgood@hl-isy.com                     emarshall@dresources.com

SOURCE HealthLeaders-InterStudy; Fingertip Formulary