Newer a-fib drugs gain popularity, despite lack of reimbursement

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Cardiologists estimate they will prescribe Bayer/Johnson & Johnson's Xarelto to 36 percent of newly diagnosed atrial fibrillation (AF) patients, while primary care physicians estimate they will prescribe Xarelto to 29 percent, according to a new survey from healthcare and pharmaceutical research firm Decision Resources.

Additionally, surveyed PCPs indicated they will prescribe Boehringer Ingelheim's Pradaxa to 28 percent of newly diagnosed AF patients.

The report found that Xarelto is the most popular emerging antithrombotic therapy among surveyed clinicians. Despite the effectiveness and widespread use of vitamin K antagonists such as warfarin (Coumadin, Bristol-Myers Squibb) for stroke prevention and heparins for venous thromboembolism prevention (VTE), both drug classes have drawbacks in safety and/or drug delivery that compromise optimal anticoagulation.

However, the survey also revealed that approximately one-third of managed-care organizations' pharmacy directors would place Xarelto, Pradaxa or Bristol-Myers Squibb/Pfizer's apixaban on Tier 2 of their formularies if these agents are proven only to be equal to warfarin for both stroke prevention efficacy and bleeding. If the only clear advantage of these novel oral anticoagulants over warfarin in stroke prevention is greater convenience (e.g. no routine monitoring or dose adjustment), most pharmacy directors said they would be unwilling to pay for greater convenience alone.

"A multitude of new anticoagulants currently in late-stage development are seeking to overcome these problems and developers of these agents could capitalize on the commercial potential offered by the large patient populations with atrial fibrillation or nonsurgical inpatients at risk of VTE," said Decision Resources Director Nikhil Mehta. "However, existing anticoagulants are well established, and older versions of these drugs are inexpensive--these factors beg the question as to whether or not prescribers and payers will support the uptake of new, more-expensive agents in this market."

The report is based on a U.S. survey of 50 cardiologists, 31 hospital internists who sit on their hospital pharmacy and therapeutics committees, 72 primary care physicians and 20 managed care organization pharmacy directors.