2009 Drug Trend Insights - Prime Therapeutics

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Spectrum Drug ManagementSpectrum Drug Pipeline andFuture TrendsFive of the key Spectrum drugcategories are likely to have thegreatest impact on drug spendbased upon the anticipated pipelineentries. These include bloodthinners, antipsychotics, seizuremedications, pain and insomnia(fig 18).+ Blood thinnersAt least five next-generationblood thinners are in advancedtesting or submitted to the FDAto treat or prevent blood clots insurgery and heart patients. Firstcandidates could reach the marketin 2009. Warfarin, a half-centuryold drug marketed as Coumadin ®by Bristol-Myers and in genericversions by other companies,is the standard option, but theside-effect profile and requiredmonitoring make it cumbersomefor patients and physicians. 34Further, drugs to compete withthe top-selling Plavix ® are in thepipeline for 2009.+ Psychosis and seizureSeveral products for psychosisand seizures are in the neartermpipeline to treat patientswith these conditions whohave potentially unmet needs.However, it is also known thatthese drugs are often widely usedfor off-label indications. Thereare seven drugs to treat these twoconditions that have the potentialto be approved in 2009, andmany approved drugs are seekingadditional indications.Generic equivalents for seizureproducts Topamax ® andDepakote ® ER were launchedin early 2009, which will helpdecrease ingredient costs andprovide an additional opportunityto improve drug mix. Expectadditional savings from genericversions of Lamictal ® , Depakote ® ,and Keppra ® in 2009 as moremanufacturers launch theirversions of these products.However, these savings could bemitigated by the introduction ofnew brand products. There areno further generic introductionsexpected within these twocategories through 2010. Giventhe current conditions, there isopportunity to manage thesemedications by restricting theiruse to their FDA-approvedindications.+ PainThere are five drugs in theshort-term pipeline to treat painand migraine. Because of thehigh abuse of these drugs, manymanufacturers are looking forways to curb the inappropriateuse of these products; therefore,abuse-deterrent products are beingdeveloped. Many of the drugs inthe pipeline are already approvedmolecular entities, combinedor administered in new ways.A generic version of triptan,Amerge ® , is expected genericallyin 2010, providing two genericalternatives within this classand offering greater potentialfor cost management.+ InsomniaThere are two new products inthe pipeline for insomnia. Oneof them is a new entity, and theother a new form of an alreadyavailable generic drug (zolpidem).This category has seen a rapidincrease in generic utilizationbecause of the launch ofzolpidem (Ambien ® ) and zaleplon(Sonata ® ); however, utilizationhas been steadily increasingas well.36 Connect ● Create
Strategic approach to Pharmacy trendsFig 18 Spectrum drugs: pipeline watchDrug Name Use Anticipated DateBrand-name DrugsIn general, if approved, these drugs are likely to impact drug trend by increasing prices. New drugs have the greatestimpact on drug spend two to five years after approval due to marketing, uptake, formulary placement, etc.Efient® (prasugrel) Blood thinner Pending approvalEmbeda (morphine & naltrexone) Pain Pending approvalMultaq® (dronedarone) Heart arrthythmia Pending approvalAmpligen® (poly I:polyC12U) Chronic fatigue syndrome Pending approvalRezonic (casopitant) Nausea & vomiting 2Q2009Serdolect® (sertindole) Psychosis 3Q2009Saphris (asenapine) Psychosis 3Q2009NA* (cethromycin) Community-acquired pneumonia 3Q2009Comfyde (carisbamate) Seizure 3Q2009Ciltyri® (eplivanserin) Insomnia 4Q2009Intermezzo® (zolpidem sublingual) Insomnia 4Q2009Solzira (gabapentin enacarbil) Restless legs 4Q2009Duodart® (dutasteride & tamsulosin) Benign prostatic hyperplasia (BPH) 1Q2010Stedesa (eslicarbazepine) Seizure 1Q2010Generic DrugsAs these drugs gain market share, they are likely to help offset brand price increases and decrease costs.fexofenadine (Allegra-D®) Allergy 4Q2009**lansoprazole (Prevacid®) Gastrointestinal 4Q2009**valacyclovir (Valtrex®) Viral infection 4Q2009***Brand drugs listed NA do not have a brand name assigned.**Anticipated dates for generic drugs are predictions made by Prime Therapeutics based on industry information.Bold drugs have the potential to be among the top 40 drugs by percent of costs, if approved.© Prime Therapeutics 2009 Drug Trend Insights37
Page 1: Connect andCreate Value2009 DRUG TR
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Page 7 and 8: Share Information. Improve Results.
Page 9 and 10: Encourage Smart Choices. Experience
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Page 24 and 25: Trends in Medicare Part DFig 8 2008
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2009 Drug Trend Insights - Prime Therapeutics

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