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U.S. Physician Prescribing Behavior Impacted by Health Insurance Exchanges and Accountable Care Organizations

BURLINGTON, Mass., Oct. 24, 2013 /PRNewswire/ -- Decision Resources Group, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that pharmaceutical companies are facing a paradigm shift in the way their brands gain access to the U.S. market, as Accountable Care Organizations (ACOs) continue to develop across the nation and enrollment on the health insurance exchanges moves forward.

"Through our comprehensive surveys of physicians and MCO executives, we're able to see how the enormous changes in the U.S. healthcare market are affecting pharmaceutical brands.  When we looked at currently available and emerging brands by therapy, it was clear that some will benefit and others will be challenged," said Roy Moore, Senior Director at Decision Resources, a Decision Resources Group company. "For instance, looking at schizophrenia and depression, physician and payer responses suggest constrained use of branded therapies on exchange-based plans because of generic competition—even though they feel Abilify and Cymbalta will remain popular therapies. In light of the new dynamics shaping reimbursement decisions, pharmaceutical brand teams looking forward to 2014 vs. backward to 2013 will be crafting market access strategies that take changes like these into account."

ACOs, of which there are more than 500 across the US, will also impact prescribing behavior and brand uptake across therapies. For example, half of surveyed pulmonologists who participate in an ACO reduced their prescribing of the branded leukotriene inhibitor Singulair—while one-third assigned more of their patients to montelukast, a generic form of the same drug favored by ACO policies such as co-pay reductions. Similarly, 43% report they are less likely to prescribe Dulera because of their participation in an ACO whereas only 13% report increased prescribing of this agent. Yet the findings show that ACOs did not universally push physicians to generics—pulmonologists are evenly split in whether they increased or decreased prescribing of Advair (a competing combination therapy), highlighting how a brand can withstand the challenges stemming from new reimbursement models.

About Physician & Payer Forum Reports—2013 "Physician & Payer Dynamics" SeriesU.S. Physician & Payer Forum is the industry's only syndicated primary market research product that includes insights from both physicians and HMO/PPO pharmacy directors to get a true sense of how both parties shape a market. The 2013 "Physician & Payer Dynamics" Series investigates how novel payer-led care coordination and financing programs impact prescribing behavior.  The Series helps pharmaceutical brand managers and marketers develop effective market access strategies within the new paradigms brought about by Healthcare Reform. Find out more here.

2013 "Physician & Payer Dynamics" Report Titles:

  • NEW Healthcare Reform: Impact of Expanding Role for Medicaid and Health Exchanges on Prescribing of Schizophrenia, Bipolar Disorder and Unipolar Depression Drugs
  • NEW Payer Strategies and Access: Narrow Networks, Employed Physicians and Provider Consolidation's Impact on Prescribing Decisions for Cardiologists – Acute Coronary Syndrome and Post-Hospital Atrial Fibrillation
  • NEW Impact of Payer-Imposed Strategies on Market Access in NSCLC and Prostate Cancer: Clinical Pathways, Bundled Payments and Accountable Care Organization Contracting
  • NEW Market Access for High-Cost Brands in Multiple Sclerosis, Oncology, and Rheumatoid Arthritis
  • NEW Accountable Care Organizations: How Will Payer and Provider Adoption of this Model Impact Prescribing Trends in Asthma and COPD?
  • E-Prescribing and Electronic Health Records: Impact of Technology on Prescribing for Hypertension and Diabetes
  • About Decision Resources Group
    Decision Resources Group 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. Please visit Decision Resources Group at

    All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.For more information, contact:  Lydia Smith

    Elizabeth MarshallDecision Resources Group

    Decision Resources Group 781-993-2594


    SOURCE Decision Resources Group
    Copyright©2012 PR Newswire.
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