Avandia formulary management post FDA advisory board

[chantell.reagan]

Anonymous question:

"What have MCOs/PBMs done with Avandia since RECORD was released (2007) and now, since the advisory committee’s review is complete? I’m looking for info on formulary changes and any utilization management strategies that may have occurred or are being considered. Also – how have/how will value based benefit designs deal with the issue?"

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[diana.papshev]

Anonymous member feedback:

"Avandia was never on our formulary, due to concerns from the very beginning that it (like most other recently approved drugs including Byetta, Symlin, Januvia and Actos) has never been shown to actually reduce the clinical events (i.e. MI, stroke, renal failure, amputation, blindness, etc) in diabetics. None of these drugs is on our value based list of drugs, only those with true clinical outcome data (i.e. insulin, metformin) are on the value based list"

[diana.papshev]

Anonymous member feedback:

"We have left Avandia on the formulary. Overall, prescribers have voted against the drug and have opted to place patients on other medications in this class. We do offer Actos on formulary along with the DPP4s and GLP-1s with PA"

[diana.papshev]

Anonymous feedback:

"We had Avandia on our formulary as well as Actos. With the recent info, our P&T voted to move Avandia to tier 3"

[diana.papshev]

Anonymous feedback:

"We have considered removing it from coverage. It hasn't been discussed formally yet. We did pull utilization and it is very low. Perhaps this will be self managing with all of the publicity"

[gary.owens]

I think Dr. David Juurlink's comment in this week's JAMA sums up the issue quite well: "Whether rosiglitazone and pioglitazone really do have different cardiovascular safety profiles is an intriguing question but one with a misplaced focus. Accumulating concerns about rosiglitazone make it difficult to advance a cogent argument regarding why, exactly, a patient might want to receive the drug or why a physician would choose to prescribe it when there is an available and quite possibly safer alternative."

[Nochmar]

I agree with Gary's comments. TZD's are great choices in the first place. I suspect Avandia will remain on many formularies considering GSK's love of bundling. It certainly will prevent many folks from removing from their formularies without taking a huge hit. By retaining formulary coverage on most plans, it provides them with a bit of an endorsement.
We're lucky that it never took off here. What little utilization we had has mainly moved to pioglitazone.