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Business Editors/Health & Medical Writers
NEWTOWN, Pa.–(BUSINESS WIRE)–Jan. 23, 2003
After only 7 months of availability, lisinopril, a generic version of the popular ACE inhibitors Prinivil and Zestril, has already significantly affected the cardiovascular market.
Since its launch in June 2002, lisinopril has gained acceptance on 97% of managed care formularies, according to Verispan’s Fall 2002 Managed Care Formulary Drug Audit. Lisinopril is largely replacing Prinivil and Zestril on many formularies.
Only 20% of managed care organizations participating in the audit reported having Prinivil on formulary in fall 2002, compared with 55% in fall 2001. Zestril’s formulary acceptance declined from 56% in spring 2002 to just 22% in fall 2002.
The semiannual audit measures formulary acceptance of individual drugs in 46 therapeutic classes. In addition, the audit tracks contract, restriction, prior authorization and third-tier status.
Lisinopril is the latest generic entrant in the ACE inhibitor market. Enalapril, a copy of Merck’s Vasotec, and captopril, the equivalent of Bristol-Myers Squibb’s Capoten, are other generics currently available.
The arrival of generic ACE inhibitors has largely forced their branded counterparts into higher-tier co-payments at most plans. Under multiple-tier benefit designs, patients are generally charged less for generic or formulary-approved medications (lower tiers), while non-formulary and specialty products cost more (higher tiers).
Zestril was reimbursed at the third tier at 70% of managed care organizations surveyed, compared with 30% of plans in spring 2002. Similarly, 68% of managed care plans placed Prinivil on the third tier in fall 2002, while only 35% did so in spring 2002.
Another major event in the cardiovascular market in 2002 was the launch of Benicar. Benicar, the newest drug in a class of medicines known as angiotensin II receptor blockers (ARBs), was introduced in April and is promoted jointly by Forest Pharmaceuticals and Sankyo.
In fall 2002, Benicar attained formulary status at 15% of surveyed managed care organizations, accounting for 29% of managed care lives tracked by the Managed Care Formulary Drug Audit.
Benicar received coverage at 70% of managed care plans, representing 60% of managed care lives. The majority of these plans, 67%, reported placing Benicar on the third tier.
P&T Committee Outcomes
Benicar was the drug discussed most often by Pharmacy & Therapeutics (P&T) committees during the 8-week reporting period of Verispan’s Fall 2002 Managed Care Pharmacy Executive Promotional Audit. A P&T committee is a panel of pharmacists and physicians from various specialties who advise a managed care plan about safe and effective use of prescription products.
A major function of the P&T committee is to develop, manage and administer formularies. Benicar was mentioned by 19 of the 58 pharmacy executives who reported P&T committee results in fall 2002.

Benicar P&T Outcomes

Total mentions 19
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Added to formulary 8
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In third tier 8
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NDC blocked 2
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Refused addition 1
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Requires prior authorization 3
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Other 1
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Source: Verispan’s Fall 2002 Managed Care Pharmacy Executive
Promotional Audit

Managed care organizations appear hesitant to add Benicar to their formularies. The ARB market currently consists of several brand-name medications with no generic competition. One pharmacist said, “It sounds better than a ‘me-too’ drug, but I am not sure if we need a third ARB.”
About the Audits
The Managed Care Formulary Drug Audit is a semiannual study of the formularies and related prescribing controls at the country’s largest, most influential managed care organizations for more than 45 therapeutic classes of drugs. The fall 2002 pharmacy executive panel represented an estimated 66% of all U.S. HMO subscribers whose drug benefits are controlled by formularies.
The Managed Care Pharmacy Executive Promotional Audit is based on the responses of pharmacy executives who represent a large portion of American lives covered by HMOs. These influential executives reported promotional activity by pharmaceutical firms over an 8-week period in fall 2002.
They also rated pharmaceutical companies on their ability to meet managed care’s needs in four areas: contracts, value-added services, knowledgeable account personnel and overall service.