title: Changes of ticagrelor formulary tiers in the USA: targeting private insurance providers away from government-funded plans.
abstract: BACKGROUND
  Ticagrelor (Brilinta®) is a new oral reversible antiplatelet agent approved by the FDA in July 2011 based on the results of the PLATO (Platelet Inhibition and Patient Outcomes) trial. However, despite very favorable and broad indications, the current clinical utilization of ticagrelor is woefully small.
  
  
  OBJECTIVE
  We aimed to compare ticagrelor formulary tiers for major private (n = 8) and government-funded (n = 4) insurance providers for 2012-2013.
  
  
  RESULTS
  Over the last year, ticagrelor placement improved, becoming a preferred drug (from Tier 3 in 2012 to Tier 2 in 2013) for Medco, moving from Tier 4 (with a prior approval requirement) to Tier 3 (no prior approval) for the United Health Care Private Plan and achieving Tier 3 status for Apex in 2013. In contrast, ticagrelor placement did not improve for New York Medicaid, retaining Tier 3 status. In addition, many Medicare Part D formularies have significantly worse coverage than most private plans. For example, Humana Medicare Part D has Tier 3 status requiring step therapy and quantity limits, SilverScript (CVS Caremark) Part D is Tier 3 and the American Association of Retired Persons (United Health Care) Medicare Part D is Tier 4 requiring prior approval.
  
  
  CONCLUSIONS
  Ticagrelor formulary placement is significantly better for most private providers than for government-funded plans, which may possibly be due to the selective targeting of private insurance providers and the simultaneous avoidance of government-funded plans.
authors.affiliation: HeartDrug® Research Laboratories, Johns Hopkins University, Towson, Md., USA.
authors.forename: Victor L
authors.initials: VL
authors.lastname: Serebruany
authors.forename: James J
authors.initials: JJ
authors.lastname: Dinicolantonio
mesh_terms: D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004363:Drug Utilization / Q000706:statistics & numerical data; D005569:Formularies as Topic; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services; D008484:Medicaid / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017149:Private Sector; D000077486:Ticagrelor; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077486:Ticagrelor; D000241:Adenosine