proven effectiveness and widespread use of vitamin K antagonists (such as warfarin)
for stroke prevention in atrial fibrillation (AF) and of heparins for venous
thromboembolism (VTE) prevention, both drug classes have major drawbacks that
compromise optimal anticoagulation. A multitude of new anticoagulants are now
in late-stage development seeking to overcome these problems and capitalize on
the commercial potential offered by the huge at-risk AF and nonsurgical
inpatient populations. However, existing anticoagulants are well established
and the older versions are inexpensive, which begs the question: Will prescribers
and payers support the uptake of new agents?
Resources’ Physician&Payer Forum report "Novel Anticoagulants
for Venous Thromboembolism and Stroke Prevention in Atrial Fibrillation: Will
Prescribers’ and Payers’ Attitudes Promote or Prevent a Shift Away from
Warfarin and Heparins?" explores clinician prescribing of novel
anticoagulants and payer attitudes to formulary coverage of emerging brands.
72 PCPs, 50 cardiologists, 31 internists who sit on their hospital pharmacy and
therapeutics (P&T) committee, and 20 managed care organization (MCO) pharmacy
directors (PDs), and compared their responses to assess similarities and
differences. This survey enabled Decision Resources to accomplish the
-- Compare the impact of six emerging anticoagulants in their most lucrative markets, stroke prevention in AF and VTE primary prophylaxis in nonsurgical (medically ill) inpatients; Bayer/J&J’s Xarelto, Boehringer Ingelheim’s Pradaxa, Bristol-Myers Squibb/Pfizer’s apixaban, Sanofi-Aventis’s idrabiotaparinux and octaparine, and ARYx’s ATI-5923 (tecarfarin).
Determine the nature of antithrombotic therapy among AF patients at low,
moderate, and high stroke risk treated by PCPs and cardiologists. What factors
influence clinicians’ decisions to prescribe or withhold antithrombotic therapy
for stroke prevention? What factors most frequently preclude warfarin
Understand what percentage of nonsurgical inpatients receives VTE prophylaxis,
based on clinician specialty and patients’ primary condition. For which
conditions is VTE primary prophylaxis underused?
how PCPs, hospital P&T committee internists, and cardiologists rank various
potential achievements of emerging anticoagulants—do they value improvements in
efficacy above improvements in bleeding risk, or vice versa? Do MCO PDs and
P&T committee internists concur?
whether MCO PDs will pay for novel anticoagulants for stroke prevention,
whether hospitals will restrict access to new agents for VTE prophylaxis, and if
so, how they will do so.
the impact that novel anticoagulants will have on postdischarge prescribing of
VTE prophylaxis in nonsurgical inpatients.
the current formulary tier assignments of available branded anticoagulants based
on plan type (including Medicare PDPs, Medicare Advantage, and private plans),
and review the cost controls imposed by agent and plan type.
likely tier placement of novel anticoagulants, based on several efficacy and
safety achievement scenarios, as well as drug pricing scenarios.