U.S. Physician and Payer Forum

March 2013

How Will U.S. Physician and Payer Attitudes and Decisions Shape the Asthma Market for Patients with Severe, Refractory Disease?

Report Authors
Colleen E. Albacker, Ph.D.
  • Pages:127
  • Tables:25
  • Figures:104
  • Citations:3
  • Drugs:5
  • Interviews:128


Currently, the majority of patients with persistent asthma successfully control their disease through the use of more-conventional inhaled agents. However, there remains a subset of patients whose disease remains uncontrolled despite full compliance with a multi-drug regimen that includes medium- or high-dose inhaled corticosteroid plus a long-acting beta2 agonist or unacceptable doses of oral corticosteroids. These patients have severe, refractory asthma, and to date, their only treatment option has been Xolair (Genentech/Novartis’s omalizumab), an IgE inhibitor launched in the United States in 2003. In the late-stage pipeline for severe asthma are three novel biologic agents and Spiriva (Boehringer Ingelheim/Pfizer’s tiotropium), which we expect to help fulfill the unmet need in this population. The entrance of these therapies will lead to the development of a more complex marketplace for severe, refractory disease, one that will require physicians and payers alike to make key decisions about which treatments to prescribe or reimburse over others. In this report, which is based on our survey of 100 pulmonologists and 28 managed care organization (MCO) pharmacy or medical directors, we examine the dynamics that will limit or promote market access of new therapies for severe, refractory asthma.

Questions Answered in This Report:

  *   Current perceptions and attitudes toward the severe, refractory asthma population: What are pulmonologists’ estimates of the size and need of this population? What are their current prescribing practices regarding Xolair? How will their prescribing change as new therapies enter the market? What utilization restrictions do payers place on Xolair? To what extent do these controls for severe, refractory agents influence prescribing?

  *   Emerging agents for severe, refractory asthma: How are the efficacy and safety profiles of the emerging therapies perceived? How will the safety and efficacy profiles of the emerging agents set them apart from each other and from current therapies? Which characteristics of these drugs are most influential in future prescribing and formulary positioning decisions? What utilization controls will be placed on the new agents, and how will those controls affect physician prescribing? How will the potential launch of biosimilar versions of omalizumab affect the prescribing and formulary positioning of the emerging biologics?

  *   Dynamics of the U.S. reimbursement environment for severe, refractory asthma: What are payers’ expectations regarding the safety and efficacy of the emerging agents? What are their expectations regarding patient screening for optimal prescribing of the emerging biologics? At what price points will novel therapies gain favorable formulary status? How will tier positioning and utilization controls affect relative line of therapy in prescribing and patient share? What clinical trial end points are payers looking for in pivotal trials? Will head-to-head trials be necessary, and if so, what comparators are preferred?


This U.S. Physician & Payer Forum investigates payer and physician dynamics that affect prescribing practices for therapies for severe, refractory asthma in the United States. The report is based on a survey of 100 pulmonologists and 28 pharmacy/medical directors at MCOs that offer commercial health insurance. We analyze current physician and payer insights and practices; their perceptions of biologics and Spiriva in the pipeline; the likely uptake of emerging therapies for severe, refractory asthma; and formulary decision making for current and emerging agents, including Genentech/Novartis’s omalizumab (Xolair), Cephalon/Teva’s reslizumab (Cinquil), GlaxoSmithKline’s mepolizumab (Bosatria), Genentech’s lebrikizumab, and Boehringer Ingelheim/Pfizer’s tiotropium (Spiriva).

Markets covered: United States.

Primary research: Online survey of 100 pulmonologists and 28 MCO pharmacy or medical directors.

Epidemiology: Asthma.

Population segments: Patients with severe, refractory asthma.

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Mentioned in this report:

  • - Boehringer Ingelheim
  • - Cephalon
  • - Genentech
  • - GlaxoSmithKline
  • - Novartis
  • - Pfizer
  • - Teva
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