U.S. Physician and Payer Forum

November 2008

Hospital Anti-Infectives: Insights on the Impact of Medicare Reforms, Formulary Inclusion, and Uptake of Novel Antibiotics and Antifungals

Report Authors
Danielle L. Drayton, Ph.D.


The hospital sector represents the most dynamic and active sector of the antibiotic and antifungal markets. In 2007, leading hospital antibiotic and antifungal brands generated more than $3.8 billion in sales in the United States. In contrast to outpatient markets that have become increasingly generic with few antibiotics in development, a range of novel agents, including next generation glycopeptides, cephalosporins, and anti-Clostridium difficile agents, are in late stages of development targeting infections in the hospital sector. Moreover, reimbursement in the hospital setting is poised to undergo significant changes in light of Medicare’s Hospital-Acquired Conditions (HAC) Initiative, effective October 1, 2008, which states that the Centers for Medicare & Medicaid Services will no longer pay hospitals at a higher rate for the additional costs of treating any of eight conditions commonly acquired during a patient’s hospital stay.

Decision Resources’ Physician&PayerForum report "Hospital Anti-Infectives: Insights on the Impact of Medicare Reforms, Formulary Inclusion, and Uptake of Novel Antibiotics and Antifungals" explores, based on the view of prescribers and pharmacy and therapeutics (P&T) committee members, how new anti-infective therapies will shape the future of the antibiotic and antifungal treatment practice in the hospital setting and how the Medicare HAC Initiative will change prescribing practices.

We surveyed 50 infectious disease (ID) specialists, 51 critical care (CC) specialists, and an additional 22 ID specialists who sit on their hospital’s P&T committee, and compared their responses to assess similarities and differences. This survey enabled Decision Resources to accomplish the following:

- Assess and compare the concerns of ID specialists, CC specialists, and P&T committee members regarding key hospital pathogens with respect to current and future therapies.

- Evaluate physicians’ usage patterns of leading antibiotic and antifungal brands and their perceptions of emerging antibacterials and antifungals.

- Evaluate the impact of Medicare’s HAC Initiative on prescribing practices and infection control/prevention measures.

- Measure the extent to which ID specialists and CC specialists plan to use novel anti-MRSA agents such as Johnson & Johnson/Basilea Pharmaceutica’s ceftobiprole, Theravance/Astellas's telavancin, Targanta’s oritavancin, and Arpida’s iclaprim in their clinical practice.

- Explore how hospital P&T committee members and physicians perceive the echinocandins (e.g., Merck’s Cancidas, Pfizer’s Eraxis, Astellas’s Mycamine) and azoles such as Pfizer’s Vfend and Schering-Plough’s Noxafil.

- Understand the drivers of hospital formulary inclusion and offer insight on how companies need to differentiate their brands to gain favorable placement.

- Evaluate the impact of the future formulary and restriction status of emerging anti-infectives on their uptake in the highly competitive hospital antibacterial market.

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