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Sertkaya A, Beleche T, Jessup A, Sommers BD. Costs of Drug Development and Research and Development Intensity in the US, 2000-2018. JAMA Netw Open 2024; 7:e2415445. [PMID: 38941099 PMCID: PMC11214120 DOI: 10.1001/jamanetworkopen.2024.15445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/23/2024] [Indexed: 06/29/2024] Open
Abstract
Importance Understanding the cost of drug development can help inform the development of policies to reduce costs, encourage innovation, and improve patient access to drugs. Objective To estimate the cost of drug development by therapeutic class and trends in pharmaceutical research and development (R&D) intensity over time. Design, Setting, and Participants In this economic evaluation study, an analytical model of drug development constructed using public and proprietary sources that collectively cover data from 2000 to 2018 was used to estimate the cost of bringing a drug to market, overall and for specific therapeutic classes. The analysis for the study was completed in October 2020. Main Outcomes and Measures Three measures of development cost from nonclinical through postmarketing stages were estimated: mean out-of-pocket cost or cash outlay, mean expected cost, and mean expected capitalized cost. Pharmaceutical R&D intensity, defined as the ratio of R&D spending to total sales, from 2008 to 2019, based on the time frame for available data, was also analyzed. Results The estimated mean cost of developing a new drug was approximately $172.7 million (2018 dollars) (range, $72.5 million for genitourinary to $297.2 million for pain and anesthesia), inclusive of postmarketing studies. The cost increased to $515.8 million when cost of failures was included. When the costs of failures and capital were included, the mean expected capitalized cost of drug development increased to $879.3 million (range, $378.7 million for anti-infectives to $1756.2 million for pain and anesthesia); results varied widely by therapeutic class. The pharmaceutical industry as a whole experienced a decline of 15.6% in sales but increased R&D intensity from 11.9% to 17.7% from 2008 to 2019. By contrast, R&D intensity of large pharmaceutical companies increased from 16.6% to 19.3%, whereas sales increased by 10.0% (from $380.0 to $418.0 billion) over the same 2008 to 2019 period, even though the cost of drug development remained relatively stable or may have even decreased. Conclusions and Relevance In this economic evaluation of new drug development costs, even though the cost of drug development appears to have remained stable, R&D intensity of large pharmaceutical companies remained relatively unchanged, despite substantial growth in revenues during this period. These findings can inform the design of drug-related policies and their potential impacts on innovation and competition.
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Affiliation(s)
| | - Trinidad Beleche
- Office of the Assistant Secretary for Planning and Evaluation, Office of Science and Data Policy, US Department of Health and Human Services, Washington, DC
| | - Amber Jessup
- Office of the Assistant Secretary for Planning and Evaluation, Office of Science and Data Policy, US Department of Health and Human Services, Washington, DC
- Now with Office of Inspector General, US Department of Health and Human Services, Washington, DC
| | - Benjamin D. Sommers
- US Department of Health and Human Services, Washington, DC
- Now with Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Chavehpour Y, Balkrishnan R, Segel JE. Prescription drug spending by payer: Implications for managed care. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100406. [PMID: 38312738 PMCID: PMC10835280 DOI: 10.1016/j.rcsop.2024.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Background Brand-name prescription drugs are an important driver of prescription drug spending, but different payers may bear these costs differentially necessitating different policy goals for each payer. But little is known about how the top 10 selling drugs in the U.S. impact spending across payers. Objective To estimate the differential spending burden of top prescription drugs on Medicaid, Medicare, commercial coverage, and out-of-pocket (OOP) spending. Methods The percentage of total prescription drug spending, total spending, total prescriptions, and average cost per prescription overall and for each of the following payers - Medicaid, Medicare, private insurance, and OOP - was calculated for each of the top 10 selling prescription drugs using 2017-2019 Medical Expenditure Panel Survey data. Results These 10 prescription drugs accounted for average annual spending of $83.4 billion and 19.0% of all prescription drug spending. Medicare tended to contribute the highest fraction of spending. The average annual cost per prescription ranged from $500 for Advair to $7400 for Tecfidera. Significant variation in the average annual number of prescriptions filled was observed, ranging from 1.4 million for Tecfidera to 13.6 million for Lantus. Conclusions The findings highlight the significant impact of the top 10 selling prescription drugs on U.S. prescription drug spending. The wide variation in per prescription cost as well as contribution to each payer's prescription drug burden emphasizes how policies targeting top-selling drugs may differentially impact payers as well as how payer-specific policies may differ substantially even for top selling drugs.
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Affiliation(s)
- Yousef Chavehpour
- Department of Health Policy and Administration, Pennsylvania State University (YC, JES), State College, PA, USA
| | - Rajesh Balkrishnan
- School of Medicine, University of Virginia (RB), Charlottesville, VA, USA
| | - Joel E Segel
- Penn State Cancer Institute, Pennsylvania State University (JES), Hershey, PA, USA
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Michaeli DT, Michaeli T. Launch and Post-Launch Prices of Injectable Cancer Drugs in the US: Clinical Benefit, Innovation, Epidemiology, and Competition. PHARMACOECONOMICS 2024; 42:117-131. [PMID: 37855850 DOI: 10.1007/s40273-023-01320-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Rising cancer drug prices adversely affect patients' adherence and survival. OBJECTIVE We aimed to identify and quantify factors associated with launch prices and post-launch price changes of injectable cancer drugs in the US from 2005 to 2023. DATA AND METHODS All anticancer drugs with US FDA approval between 2000 and 2022 were identified in the Drugs@FDA database. The sample was then restricted to cancer drugs covered under Medicare Part B (injectable drugs). Data characterizing each drug's clinical benefits, disease epidemiology, approved indications, competition, and price were obtained from FDA labels, the Global Burden of Disease study, and the Centers for Medicare and Medicaid Services. The association between launch/post-launch prices and collected variables was assessed in random-effects regressions. RESULTS Of 170 cancer drugs with FDA approval between 2000 and 2022, we identified 66 (39%) injectable cancer drugs with quarterly price data from 2005 to 2023. In 2023, mean prices amounted to $27,688 per month, with an average price increase of 94% from 2005 to 2023. Launch and post-launch price changes were significantly associated with the treated disease epidemiology. A 1% decline in disease incidence was associated with a 0.2511% (p = 0.008) increase in launch prices and a 0.0086% (p = 0.032) annual increase in post-launch prices. Accordingly, launch prices were 120% (p = 0.051) higher for orphan than non-orphan drugs, with 3% (p = 0.008) greater annual post-launch price increases. Post-launch prices declined by up to -2% annually as new supplemental indications were approved for the same drug. We found no consistent association between launch/post-launch prices and the drugs' clinical benefit in terms of overall survival, progression-free survival, and tumor response. The market entry of new competitors was not associated with price reductions. 28 of 33 drug pairs within the same class had positive correlation coefficients. Pearson correlation coefficients were high (>0.80) for PD-1/PD-L1 inhibitors, CD38 antibodies, CD20 antibodies, HER2 antibodies, and mTOR inhibitors. CONCLUSIONS Cancer drug prices regularly increase faster than inflation; however, there is no evidence that launch prices and post-launch price changes are aligned with the clinical benefit a drug offers to patients. In particular, patients with rare diseases experience greater price increases for their orphan drugs. There is no evidence that brand-brand competition results in drug price reductions.
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Affiliation(s)
- Daniel Tobias Michaeli
- Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
| | - Thomas Michaeli
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
- DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
- Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Reitsma MB, Dusetzina SB, Ballreich JM, Trujillo AJ, Mello MM. Examining Opportunities to Increase Savings From Medicare Price Negotiations. JAMA Intern Med 2023; 183:581-588. [PMID: 37067794 PMCID: PMC10111230 DOI: 10.1001/jamainternmed.2023.0763] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/17/2023] [Indexed: 04/18/2023]
Abstract
Importance Allowing the US Centers for Medicare & Medicaid Services to negotiate prescription drug prices for Medicare may improve drug affordability. Objective To estimate savings from Medicare price negotiation under the Inflation Reduction Act (IRA) and examine opportunities to increase savings. Design, Setting, and Participants This cross-sectional, population-based study used data from 2020 Medicare prescription drug claims. The study was conducted and data were analyzed in 2022. Exposures Eligibility for Medicare price negotiation under the IRA and alternative criteria. Main Outcomes and Measures Minimum savings under the IRA's eligibility criteria were estimated and compared with savings within alternative scenarios, including (1) selecting drugs for negotiation based on net spending after rebates rather than gross spending; (2) extending eligibility to drugs with biosimilar or generic competitors; (3) reducing the minimum years since US Food and Drug Administration approval for eligibility; and (4) changing 2 or 3 of these factors. Estimated savings were calculated at different levels of scale-up of price negotiation under the IRA, from 10 Part D drugs in 2026 to 60 Part B and D drugs in 2029. Gross spending was calculated using the US Centers for Medicare & Medicaid Services 2020 Medicare drug spending dashboard. Rebates were estimated using SSR Health data. Information on FDA approvals, generics, and biosimilars was obtained from FDA websites. Results Under IRA rules, estimated minimum savings from price negotiation in 2026 for 10 Part D drugs would be $3.2 billion. For 2029 for 60 Part D and B drugs, estimated savings were $16.0 billion. Selecting drugs for negotiation based on net rather than gross spending would be associated with estimated savings of $4.6 billion (a 45% increase) in 2026 and $18.9 billion (an 18% increase) in 2029. Including drugs with generic competitors or biosimilars would be associated with an estimated savings of $6.6 billion (a 109% increase) in 2026 and $24.9 billion (a 56% increase) in 2029. Making both changes would be associated with savings of $9.5 billion (a 200% increase) in 2026 and $28.3 billion (a 77% increase) in 2029. A sensitivity analysis suggested that reducing the required number of years since marketing approval by 2 years would be associated with increased estimated savings of 4% when 10 Part D drugs are negotiated and 12% when 60 Part D and B drugs are negotiated. Changing all 3 criteria would be associated with the greatest increase in estimated savings in 2029 (119% increase when 10 Part D drugs are negotiated and 93% increase for 60 Part D and B drugs). Conclusions and Relevance The results of this cross-sectional study suggest that adjusting the eligibility criteria for Medicare prescription drug price negotiation to permit inclusion of drugs with biosimilar or generic competitors and selecting drugs based on net rather than gross spending may be a promising approach to substantially increase estimated savings.
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Affiliation(s)
- Marissa B. Reitsma
- Department of Health Policy and Freeman Spogli Institute for International Studies, Stanford University School of Medicine, Stanford, California
| | - Stacie B. Dusetzina
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeromie M. Ballreich
- Department of Health Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Antonio J. Trujillo
- Department of Health Policy and Management and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Michelle M. Mello
- Department of Health Policy and Freeman Spogli Institute for International Studies, Stanford University School of Medicine, Stanford, California
- Stanford Law School, Stanford, California
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Gressler LE, Crowley K, Berliner E, Leroy H, Krofah E, Eloff B, Marinac-Dabic D, Vythilingam M. A Quantitative Framework to Identify and Prioritize Opportunities in Biomedical Product Innovation: A Proof-of-Concept Study. JAMA HEALTH FORUM 2023; 4:e230894. [PMID: 37145687 PMCID: PMC10163391 DOI: 10.1001/jamahealthforum.2023.0894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/10/2023] [Indexed: 05/06/2023] Open
Abstract
Importance Prioritization and funding for health initiatives, including biomedical innovation, may not consistently target unmet public health needs. Objective To (1) develop a quantitative, databased framework to identify and prioritize opportunities for biomedical product innovation investments based on a multicriteria decision-making model (MCDM) that includes comprehensive measures of public health burden and health care costs, and (2) pilot test the model. Design, Setting, and Participants The Department of Health and Human Services (HHS) convened public and private experts to develop a model, select measures, and complete a longitudinal pilot study to identify and prioritize opportunities for investment in biomedical product innovations that have the greatest public health benefit. Cross-sectional and longitudinal data (2012-2019) for 13 pilot medical disorders were obtained from the Institute for Health Metrics Global Burden of Disease database (IHME GBD) and the National Center for Health Statistics (NCHS). Main Outcome Measures The main outcome measure was an overall gap score reflecting high public health burden (composite measure of mortality, prevalence, years lived with disability, and health disparities), or high health care costs (composite measure of total, public, and out-of-pocket health spending) relative to low biomedical innovation. Sixteen innovation metrics were selected to reflect the pipeline of biomedical products from research and development to market approval. A higher score indicates a greater gap. Normalized composite scores were calculated for public health burden, cost, and innovation investment using the MCDM Technique for Order of Preference by Similarity to Ideal Solution method. Results Among the 13 conditions tested in the pilot study, diabetes (0.61), osteoarthritis (0.46), and drug-use disorders (0.39) had the highest overall gap score reflecting high public health burden, or high health care costs relative to low biomedical innovation in these medical disorders. Chronic kidney disease (0.05), chronic obstructive pulmonary disease (0.09), and cirrhosis and other liver diseases (0.10) had the least amount of biomedical product innovation despite similar public health burden and health care cost scores. Conclusions In this cross-sectional pilot study, we developed and implemented a data-driven, proof-of-concept model that can help identify, quantify, and prioritize opportunities for biomedical product innovation. Quantifying the relative alignment between biomedical product innovation, public health burden, and health care cost may help identify and prioritize investments that can have the greatest public health benefit.
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Affiliation(s)
- Laura Elisabeth Gressler
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
- University of Arkansas for Medical Sciences, Little Rock
| | - Kenyon Crowley
- Robert H. Smith School of Business, University of Maryland, College Park
- Accenture Federal Services, Arlington, Virginia
| | | | - Hartley Leroy
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Esther Krofah
- Faster Cures and Center for Public Health, Milken Institute, Washington, DC
| | - Benjamin Eloff
- Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Meena Vythilingam
- Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
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6
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Rand LZ, Melendez‐Torres GJ, Kesselheim AS. Alternatives to the quality-adjusted life year: How well do they address common criticisms? Health Serv Res 2023; 58:433-444. [PMID: 36537647 PMCID: PMC10012222 DOI: 10.1111/1475-6773.14116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To analyze whether other outcome measures used in health technology assessment (HTA) address the criticisms of quality-adjusted life years (QALYs). DATA SOURCES AND STUDY SETTING HTA methods guidance from 11 US comparator countries (the G10 and Australia) and six value frameworks from US organizations were reviewed to identify health outcome measures currently used to evaluate the benefits of a drug. STUDY DESIGN The study involved a documentary analysis of guidelines to identify outcome measures used by the sampled HTA organizations. Similar outcomes were grouped together into outcome types. Each type was analyzed to determine the extent to which it replicates key advantages and responds to criticisms of QALYs extracted from the literature. EXTRACTION METHODS Outcomes were included if guidance from at least one HTA organization identified the outcome as acceptable for HTA. Outcomes measuring or evaluating the benefit, clinical effect, or impact of a drug or health technology was included; methods of calculating costs were excluded. PRINCIPAL FINDINGS Seven types of outcome measures were identified falling into three groups: preference-based, single-dimension outcomes, and outcomes using non-health perspectives. Among the seven QALY alternative outcome measures currently used for HTA by the sampled countries, no one outcome measure addresses all the QALY criticisms while retaining the advantageous features of the QALY. CONCLUSIONS Proposals to adopt health technology assessment (HTA) to support value-based pricing of prescription drugs in the US have faced pushback over the use of the QALY. There is no single "right" outcome measure, and the criticisms of QALYs apply to other outcome measures used to evaluate health. The measures identified have different features and strengths, which may be appropriate for specific decision making goals, but the QALY remains the best option for decision making that requires comparisons of the overall societal value of health gains.
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Affiliation(s)
- Leah Z. Rand
- The Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Center for BioethicsHarvard Medical SchoolBostonMassachusettsUSA
| | - G. J. Melendez‐Torres
- Peninsula Technology Assessment Group (PenTAG), Faculty of Health and Life SciencesUniversity of ExeterExeterUK
| | - Aaron S. Kesselheim
- The Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Center for BioethicsHarvard Medical SchoolBostonMassachusettsUSA
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Luo J, Feldman R, Rothenberger S, Korytkowski M, Fischer MA, Gellad WF. Incidence and Predictors of Primary Nonadherence to Sodium Glucose Co-transporter 2 Inhibitors and Glucagon-Like Peptide 1 Agonists in a Large Integrated Healthcare System. J Gen Intern Med 2022; 37:3562-3569. [PMID: 35048301 PMCID: PMC9585108 DOI: 10.1007/s11606-021-07331-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Newer glucose-lowering drugs, including sodium glucose co-transporter 2 inhibitors (SGLT2i) and GLP-1 agonists, have a key role in the pharmacologic management of type 2 diabetes. No studies have measured primary nonadherence for these two drug classes, defined as when a medication is prescribed for a patient but ultimately not dispensed to them. OBJECTIVE To describe the incidence and predictors of primary nonadherence to SGLT2i (canagliflozin, empagliflozin) or GLP-1 agonists (dulaglutide, liraglutide, semaglutide) using a dataset that links electronic prescribing with health insurance claims. DESIGN AND PARTICIPANTS A retrospective cohort design using data of adult patients from a large health system who had at least one prescription order for a SGLT2i or GLP-1 agonist between 2012 and 2019. We used mixed-effects multivariable logistic regression to determine associations between sociodemographic, clinical, and provider variables and primary nonadherence. MAIN MEASURES Primary medication nonadherence, defined as no dispensed claim within 30 days of an electronic prescription order for any drug within each medication class. KEY RESULTS The cohort included 5146 patients newly prescribed a SGLT2i or GLP-1 agonist. The overall incidence of 30-day primary medication nonadherence was 31.8% (1637/5146). This incidence rate was 29.8% (n = 726) and 33.6% (n = 911) among those initiating a GLP-1 agonist and SGLT2i, respectively. Age ≥ 65 (aOR 1.37 (95% CI 1.09 to 1.72)), Black race vs White (aOR 1.29 (95% CI 1.02 to 1.62)), diabetic nephropathy (aOR 1.31 (95% CI 1.02 to 1.68)), and hyperlipidemia (aOR 1.18 (95% CI 1.01 to 1.39)) were associated with a higher odds of primary nonadherence. Female sex (aOR 0.86 (95% CI 0.75 to 0.99)), peripheral artery disease (aOR 0.73 (95% CI 0.56 to 0.94)), and having the index prescription ordered by an endocrinologist vs a primary care provider (aOR 0.76 (95% CI 0.61 to 0.95)) were associated with lower odds of primary nonadherence. CONCLUSIONS One third of patients prescribed SGLT2i or GLP-1 agonists in this sample did not fill their prescription within 30 days. Black race, male sex, older age, having greater baseline comorbidities, and having a primary care provider vs endocrinologist prescribe the index drug were associated with higher odds of primary nonadherence. Interventions targeting medication adherence for these newer drugs must consider primary nonadherence as a barrier to optimal clinical care.
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Affiliation(s)
- Jing Luo
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburg, PA, USA.
| | - Robert Feldman
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
| | - Scott Rothenberger
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
| | - Mary Korytkowski
- Division of Endocrinology and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
| | - Walid F Gellad
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburg, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
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8
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Thomas CM, Shae W, Koestler D, DeFor T, Bahr N, Alpern JD. Antifungal drug price increases in the United States, 2000-2019. Mycoses 2022; 65:859-865. [PMID: 35722703 PMCID: PMC9378588 DOI: 10.1111/myc.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Antifungal drugs treat a variety of conditions, ranging from localised dermatologic disease to life-threatening systemic infections. Some common antifungal drugs experienced large price increases in recent years, however, factors contributing to these price increases are poorly understood. We sought to examine trends in antifungal drug prices and determine underlying drivers of price changes. METHODS Antifungal drug products in the United States were identified using the Food and Drug Administration (FDA) Label database. For each product, we determined the wholesale acquisition cost per unit over time between 2000 and 2019, adjusting for inflation, and examined variables that could impact price: route of administration, number of FDA indications, the quantity of professional guideline recommendations, use for prophylaxis, number of FDA-approved manufacturers, and whether it was compounded. Price trajectories were clustered into four groups: (1) stable, 2) moderate, (3) high, and (4) extreme price increases. RESULTS Of 139 identified drug products, one outlier was removed due to exorbitant price increases. Cluster 1 (n = 31) demonstrated the most stable prices with a 25% mean price increase. Clusters 2 (n = 97), 3 (n = 7), and 4 (n = 3) demonstrated moderate, high, and extreme price increases with 52%, 318%, and 900% mean price increases, respectively. Atypical routes of administration and compounding were over-represented in clusters 3 and 4. There was no correlation between the number of manufacturers and price changes. CONCLUSIONS Antifungal drugs exhibited large, inflation-adjusted price increases. Atypical routes of administration and compounding were over-represented within clusters exhibiting extraordinary price increases. Our data support policies aiming to curb large price increases for medically important drugs.
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Affiliation(s)
- Christine M. Thomas
- Division of Infectious Diseases and International Medicine, Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Whitney Shae
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Devin Koestler
- Department of Biostatistics & Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | | | - Nathan C. Bahr
- Division of Infectious Diseases, Department of MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Jonathan D. Alpern
- Division of Infectious Diseases and International Medicine, Department of MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
- HealthPartners InstituteBloomingtonMinnesotaUSA
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Wouters OJ, Berenbrok LA, He M, Li Y, Hernandez I. Association of Research and Development Investments With Treatment Costs for New Drugs Approved From 2009 to 2018. JAMA Netw Open 2022; 5:e2218623. [PMID: 36156148 PMCID: PMC9513642 DOI: 10.1001/jamanetworkopen.2022.18623] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Drug companies frequently claim that high prices are needed to recoup spending on research and development. If high research and development costs justified high drug prices, then an association between these 2 measures would be expected. OBJECTIVE To examine the association between treatment costs and research and development investments for new therapeutic agents approved by the US Food and Drug Administration (FDA) from 2009 to 2018. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed 60 drugs approved by the FDA between January 1, 2009, and December 31, 2018, for which data on research and development investments and list or net prices were available. Data sources included the FDA and SSR Health databases. MAIN OUTCOMES AND MEASURES The primary independent variable was estimated research and development investment. The outcome was standardized treatment costs (ie, annual treatment costs for both chronic and cycle drugs, and treatment costs for the maximum length of treatment recommended for acute drugs). Standardized treatment costs were estimated separately using list and net prices obtained from SSR Health at the time of launch and in 2021. To test the association between research and development investments and treatment costs, correlation coefficients were estimated and linear regression models were fitted that controlled for other factors that were associated with treatment costs, such as orphan status. Two models were used: a fully adjusted model that was adjusted for all variables in the data set associated with treatment costs and a parsimonious model in which highly correlated variables were excluded. RESULTS No correlation was observed between estimated research and development investments and log-adjusted treatment costs based on list prices at launch (R = -0.02 and R2 = 0.0005; P = .87) or net prices 1 year after launch (R = 0.08 and R2 = 0.007; P = .73). This result held when 2021 prices were used to estimate treatment costs. The linear regression models showed no association between estimated research and development investments and log-adjusted treatment costs at launch (β = 0.002 [95% CI, -0.02 to 0.02; P = .84] in the fully adjusted model; β = 0.01 [95% CI, -0.01 to 0.03; P = .46] in the parsimonious model) or from 2021 (β = -0.01 [95% CI, -0.03 to 0.01; P = .30] in the fully adjusted model; β = -0.004 [95% CI, -0.02 to 0.02; P = .66] in the parsimonious model). CONCLUSIONS AND RELEVANCE Results of this study indicated that research and development investments did not explain the variation in list prices for the 60 drugs in this sample. Drug companies should make further data available to support their claims that high drug prices are needed to recover research and development investments, if they are to continue to use this argument to justify high prices.
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Affiliation(s)
- Olivier J. Wouters
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Lucas A. Berenbrok
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Meiqi He
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla
| | - Yihan Li
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Inmaculada Hernandez
- Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla
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10
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Trujillo AJ, Gutierrez JC, Garcia Morales EE, Socal M, Ballreich J, Anderson G. Trajectories of prices in generic drug markets: what can we infer from looking at trajectories rather than average prices? HEALTH ECONOMICS REVIEW 2022; 12:37. [PMID: 35819735 PMCID: PMC9278003 DOI: 10.1186/s13561-022-00384-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Well-functioning competitive markets are key to controlling generic drug prices. This is important since over 90% of all drugs sold in the US are generics. Recently, there have been examples of large price increases in the generic market. METHODS This paper examines price trajectories for generic drugs using a group-based trajectory modelling approach (GBTM). We fit the model using quarterly price information in the IBM MarketScan claims database for the past decade. RESULTS We identify three dominant price trajectories for this period: rapid increase trajectories, slow decline and rapid decline. Most generic drugs show a slow or a rapid decline in price trajectories. However, around 17% of all generic drugs show rapid price increase trajectories. CONCLUSIONS As Congress is exploring an excise tax on drugs whose list price increases faster than the rate of inflation, we discuss what drugs would be most likely to be affected by this law.
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Affiliation(s)
- Antonio J. Trujillo
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Jose C. Gutierrez
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | | | - Mariana Socal
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Jeromie Ballreich
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Gerard Anderson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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11
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Silverman C, Ng BP, Baek C, Park C. Prescription drug coverage satisfaction and medication nonadherence among Medicare beneficiaries with cancer. Expert Rev Pharmacoecon Outcomes Res 2022; 22:971-979. [PMID: 35484941 DOI: 10.1080/14737167.2022.2064846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Medication nonadherence among older patients with cancer can have profound health consequences. This study examines the association between prescription drug coverage satisfaction and medication nonadherence among Medicare beneficiaries with cancer. METHODS We analyzed the 2017 Medicare Current Beneficiary Survey Public Use File of beneficiaries aged ≥65 years with reported non-skin cancer (n = 806). Beneficiaries were considered to have medication nonadherence if they reported: skipping doses, taking smaller doses than prescribed, or delaying or not filling a prescription because of cost. A survey-weighted logistic model, adjusted for covariates, was conducted to examine the association between prescription drug coverage satisfaction and medication nonadherence. RESULTS Of study beneficiaries with cancer, 14.7% reported medication nonadherence. Higher proportions of beneficiaries with medication nonadherence were dissatisfied with the amount paid for medications (33.2% vs. 11.0%, p < 0.001) and the medications included on formulary (29.5% vs 5.2%, p < 0.001). In the adjusted analysis, the risk for medication nonadherence was higher among those who were dissatisfied with the amount paid for medications (OR = 2.22; p = 0.050) and the medications included on formulary (OR = 5.03; p = 0.005). CONCLUSIONS Strategic mitigation of these barriers is essential to improving health outcomes in this at-risk population.
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Affiliation(s)
- Ciara Silverman
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Boon Peng Ng
- College of Nursing, University of Central Florida, Orlando, Fl, Usa and Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, USA
| | - Chaewon Baek
- Department of Pharmacy and Health Systems Sciences, School of Pharmacy, Northeastern University, Boston, MA, USA
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, the University of Texas at Austin, Austin, Tx, USA
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12
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Maraj D, Steiner L, Persaud N. Essential tuberculosis medicines and health outcomes in countries with a national essential medicines list. J Clin Tuberc Other Mycobact Dis 2022; 27:100305. [PMID: 35308809 PMCID: PMC8924688 DOI: 10.1016/j.jctube.2022.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Tuberculosis (TB) remains a major cause of morbidity and mortality globally despite effective treatments. Along with high-quality health services, essential medicines are a key tool in curbing TB related mortality. Examining relationships between listing TB medicines on national essential medicines lists (NEMLs) and population health outcomes related to amenable mortality is one way to assess TB care. Methods In this cross-sectional study of 137 countries, we used linear regression to examine the relationship between the number of TB medicines listed on NEMLs and TB related mortality while controlling for country income, region and TB burden. Results Most countries listed essential TB medicines to treat latent, drug-sensitive and disseminated TB but few listed enough for multi-drug resistant TB (MDR-TB) therapy. The total number of TB medicines listed ranged from 1 to 29 (median: 19, interquartile range: 15 to 22). Over 75% of the variation in health outcomes were explained by the number of TB medicines listed, gross domestic product (GDP) per capita, region and high-burden MDR-TB status. The number of TB medicines listed was not associated with TB mortality. Conclusion Most countries list essential TB treatments and the variation in TB outcomes is explained by other factors such as GDP.
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13
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Russell HV, Chi YY, Okcu MF, Bernhardt MB, Rodriguez-Galindo C, Gupta AA, Hawkins DS. Rising drug cost impacts on cost-effectiveness of 2 chemotherapy regimens for intermediate-risk rhabdomyosarcoma: A report from the Children's Oncology Group. Cancer 2022; 128:317-325. [PMID: 34623638 PMCID: PMC8738099 DOI: 10.1002/cncr.33917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/05/2021] [Accepted: 08/09/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Children's Oncology Group clinical trial for intermediate risk rhabdomyosarcoma randomized participants to a combination of vincristine, dactinomycin, and cyclophosphamide (VAC) alone or VAC alternating with vincristine plus irinotecan (VAC/VI). Clinical outcomes were similar, but toxicity profiles differed. This study estimates the cost differences between arms from the health care system's perspective. METHODS A decision-analytic model was used to estimate the incremental cost-effectiveness ratio (ICER) of VAC versus VAC/VI. Protocol-required or recommended medications and laboratory studies were included. Costs were obtained from national databases or supporting literature and inflated to 2019 US dollars. Demographic and outcome data were obtained from the clinical trial and directed chart reviews. Life-years (LY) were estimated from life-expectancy tables and discounted by 3% annually. Probabilistic sensitivity analyses and alternative clinical scenarios identified factors driving costs. RESULTS Mean direct medical costs of VAC and VAC/VI were $164,757 and $102,303, respectively. VAC was associated with an additional 0.97 LY and an ICER of $64,386/LY compared with VAC/VI. The ICER was sensitive to survival estimations and to alternative clinical scenarios including outpatient cyclophosphamide delivery (ICER $49,037/LY) or substitution of alternative hematopoietic growth factor schedules (ICER $73,191-$91,579/LY). Applying drug prices from 2012 decreased the total costs of VAC by 20% and VAC/VI by 15% because of changes in dactinomycin and pegfilgrastim prices. CONCLUSIONS Neither arm was clearly more cost-effective. Pharmaceutical pricing and location of treatment drove costs and may inform future treatment decisions. Rising pharmaceutical costs added $30,000 per patient, a finding important for future drug-pricing policy decisions. LAY SUMMARY Two chemotherapy regimens recently tested side-by-side for rhabdomyosarcoma had similar tumor outcomes, but different side effects. The health care costs of each regimen were compared; neither was clearly more cost-effective. However, the costs of each treatment changed dramatically with choices of supportive medicines and location of treatment. Costs of treatment rose by 15% to 20% because of rising US drug costs not associated with the clinical trial.
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Affiliation(s)
- Heidi V Russell
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Yueh-Yun Chi
- Department of Pediatrics and Preventative Medicine, University of Southern California, Los Angeles, California
| | - M Fatih Okcu
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | - M Brooke Bernhardt
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas
| | | | - Abha A Gupta
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Douglas S Hawkins
- Seattle Children's Hospital, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, Washington
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14
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Horvitz-Lennon M, Volya R, Hollands S, Zelevinsky K, Mulcahy A, Donohue JM, Normand SLT. Factors Associated With Off-Label Utilization of Second-Generation Antipsychotics Among Publicly Insured Adults. Psychiatr Serv 2021; 72:1031-1039. [PMID: 34074139 PMCID: PMC8410611 DOI: 10.1176/appi.ps.202000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Off-label utilization of second-generation antipsychotic medications may expose patients to significant risks. The authors examined the prevalence, temporal trends, and factors associated with off-label utilization of second-generation antipsychotics among publicly insured adults. METHODS A retrospective repeated panel was used to examine monthly off-label utilization of second-generation antipsychotics among fee-for-service Medicare, Medicaid, and dually eligible White, Black, and Latino adult beneficiaries filling prescriptions for second-generation antipsychotics in California, Georgia, Mississippi, and Oklahoma from July 2008 through June 2013. RESULTS Among 301,367 users of second-generation antipsychotics, between 36.5% and 41.9% had utilization that was always off-label. Payer did not modify effects of race-ethnicity on off-label utilization. Compared with Whites, Blacks had lower monthly odds of off-label utilization in all four states, and Latinos had lower odds of utilization in California and Georgia. Payer was associated with off-label utilization in California, Mississippi, and Oklahoma. California Medicaid beneficiaries were 1.12 (95% confidence interval=1.10-1.13) times as likely as dually eligible beneficiaries to have off-label utilization. Off-label utilization increased relative to the baseline year in all states, but a downward trend followed in three states. CONCLUSIONS Off-label utilization of second-generation antipsychotics was prevalent despite the drugs' cardiometabolic risks and little evidence of their effectiveness. The lower likelihood of off-label utilization among patients from racial-ethnic minority groups might stem from prescribers' efforts to minimize risks, given a higher baseline risk for these groups, or from disparities-associated factors. Variation among payers suggests that payer policies can affect off-label utilization.
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Affiliation(s)
- Marcela Horvitz-Lennon
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Rita Volya
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Simon Hollands
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Katya Zelevinsky
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Andrew Mulcahy
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Julie M Donohue
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Sharon-Lise T Normand
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
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15
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Park J, Zhang P, Wang Y, Zhou X, Look KA, Bigman ET. High Out-of-pocket Health Care Cost Burden Among Medicare Beneficiaries With Diabetes, 1999-2017. Diabetes Care 2021; 44:1797-1804. [PMID: 34183427 PMCID: PMC8376067 DOI: 10.2337/dc20-2708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/17/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined the magnitude of and trends in the burden of out-of-pocket (OOP) costs among Medicare beneficiaries age 65 years or older with diabetes overall, by income level, by race/ethnicity, and compared with beneficiaries without diabetes. RESEARCH DESIGN AND METHODS Using data from the 1999-2017 Medicare Current Beneficiary Survey, we estimated average annual per capita OOP costs and percentage of beneficiaries experiencing high OOP burden, defined as OOP costs >10% or >20% of household income. We used joinpoint regression to examine the trends and generalized linear model and logistic regression for comparisons between beneficiaries with and without diabetes. Cost and income estimates were adjusted to 2017 USD. RESULTS Total OOP costs were $3,609-$5,283, with significant increases until 2005 followed by a leveling off. The prevalence of high OOP burden was 57%-72% at the 10% income threshold and 29%-41% at the 20% threshold, with significant increasing trends until 2003 followed by decreases. Total OOP costs were the highest in the ≥75% income quartile, whereas prevalence of high OOP burden was highest in the <25% and 25-50% income quartiles. Non-Hispanic Whites had the highest OOP costs and prevalence of high OOP burden. Beneficiaries with diabetes had significantly higher OOP costs ($498, P < 0.01) and were more likely to have high OOP burden than those without diabetes (odds ratios 1.32 and 1.25 at >10% and >20% thresholds, respectively, P < 0.01). CONCLUSIONS Over the past two decades, Medicare beneficiaries age 65 years or older with diabetes have faced substantial OOP burden, with large income-related disparities.
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Affiliation(s)
- Joohyun Park
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin A Look
- Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI
| | - Elizabeth T Bigman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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16
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Zhang H, Cowling DW, Graham JM, Taylor E. Impact of a commercial accountable care organization on prescription drugs. Health Serv Res 2021; 56:592-603. [PMID: 33508877 PMCID: PMC8313955 DOI: 10.1111/1475-6773.13626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine the long-run impact of a commercial accountable care organization (ACO) on prescription drug spending, utilization, and related quality of care. DATA SOURCES/STUDY SETTING California Public Employees' Retirement System (CalPERS) health maintenance organization (HMO) member enrollment data and pharmacy benefit claims, including both retail and mail-order generic and brand-name prescription drugs. STUDY DESIGN We applied a longitudinal retrospective cohort study design and propensity-weighted difference-in-differences regression models. We examined the relative changes in outcome measures between two ACO cohorts and one non-ACO cohort before and after the ACO implementation in 2010. The ACO directed provider prescribing patterns toward generic substitution for brand-name prescription drugs to maximize shared savings in pharmacy spending. DATA COLLECTION/EXTRACTION METHODS The study sample included members continuously enrolled in a CalPERS commercial HMO from 2008 through 2014 in the Sacramento area. PRINCIPAL FINDINGS The cohort differences in baseline characteristics of 40 483 study participants were insignificant after propensity-weighting adjustment. The ACO enrollees had no significant differential changes in either all or most of the five years of the ACO operation for the following measures: (1) average total spending and (2) average total scripts filled and days supplied on either generic or brand-name prescription drugs, or the two combined; (3) average generic shares of total prescription drug spending, scripts filled or days supplied; (4) annual rates of 10 outpatient process quality of care metrics for medication prescribing or adherence. CONCLUSIONS Participation in the commercial ACO was associated with negligible differential changes in prescription drug spending, utilization, and related quality of care measures. Capped financial risk-sharing and increased generics substitution for brand names are not enough to produce tangible performance improvement in ACOs. Measures to increase provider financial risk-sharing shares and lower brand-name drug prices are needed.
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Affiliation(s)
- Hui Zhang
- Health Policy Research DivisionCalifornia Public Employees' Retirement SystemSacramentoCaliforniaUSA
| | - David W. Cowling
- Health Policy Research DivisionCalifornia Public Employees' Retirement SystemSacramentoCaliforniaUSA
| | - Joanne M. Graham
- Health Policy Research DivisionCalifornia Public Employees' Retirement SystemSacramentoCaliforniaUSA
| | - Erik Taylor
- Health Policy Research DivisionCalifornia Public Employees' Retirement SystemSacramentoCaliforniaUSA
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17
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Patel A, Oluwole O, Savani B, Dholaria B. Taking a BiTE out of the CAR T space race. Br J Haematol 2021; 195:689-697. [PMID: 34131894 DOI: 10.1111/bjh.17622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 12/22/2022]
Abstract
Chimaeric antigen receptor T-cell (CAR T) therapy has evolved at an exponential pace and seeks to revolutionize the CAR T space with next-generation CARs and expanding indications in plasma cell dyscrasias. Recent developments in Bispecific T-cell engager therapy (BiTEs) may level the playing field with CAR T therapy, offering key advantages with off-the-shelf or on-demand treatment and a manageable toxicity profile to encompass a wider pool of eligible patients in the outpatient setting. The coexistence of both modalities will remain important in overall management and accelerate the next iteration of both cellular and BiTEs. This article summarises the current progress, potential future of both therapies for haematologic malignancies, and their economic implications on the healthcare system.
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Affiliation(s)
- Ameet Patel
- Department of Hematology and Bone Marrow Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Olalekan Oluwole
- Department of Hematology and Bone Marrow Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bipin Savani
- Department of Hematology and Bone Marrow Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Hematology/Stem Cell Transplant, Veteran Hospital Administration, Nashville, TN, USA
| | - Bhagirathbhai Dholaria
- Department of Hematology and Bone Marrow Transplant, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
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18
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Sarpatwari A, Tessema FA, Zakarian M, Najafzadeh MN, Kesselheim AS. Diabetes Drugs: List Price Increases Were Not Always Reflected In Net Price; Impact Of Brand Competition Unclear. Health Aff (Millwood) 2021; 40:772-778. [PMID: 33939506 DOI: 10.1377/hlthaff.2020.01436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
List prices for brand-name drugs have risen steeply, often despite the introduction of competition from other brand-name drugs in the same therapeutic class. List prices, however, do not reflect any rebates that manufacturers provide payers. To understand how net prices (after rebates and other discounts) respond to competition, we compared changes in inflation-adjusted, revenue-weighted mean list and net prices of a one-month supply of three classes of diabetes drugs: glucagon-like peptide 1 (GLP1) agonists, dipeptidyl peptidase 4 (DPP4) inhibitors, and sodium glucose cotransporter 2 (SGLT2) inhibitors. These drug classes each had several brand-name products enter the market between 2005 and 2017. The annualized change in list price over this period was $75 (15 percent) for GLP1 agonists, $22 (8 percent) for DPP4 inhibitors, and $41 (11 percent) for SGLT2 inhibitors. In contrast, the annualized change in net price was $38 (10 percent) for GLP1 agonists, -$3 (-2 percent) for DPP4 inhibitors, and -$17 (-9 percent) for SGLT2 inhibitors, suggesting a variable impact of brand-name competition on net prices.
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Affiliation(s)
- Ameet Sarpatwari
- Ameet Sarpatwari is an assistant professor of medicine and the assistant director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, in Boston, Massachusetts
| | - Frazer A Tessema
- Frazer A. Tessema was a research assistant in the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, when this work was completed. He is an MD candidate at the University of Chicago Pritzker School of Medicine, in Chicago, Illinois
| | - Marie Zakarian
- Marie Zakarian is a product manager at Human Care Systems, in Boston, Massachusetts. She was a research assistant in the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, when this work was performed
| | - Mehdi N Najafzadeh
- Mehdi N. Najafzadeh is an assistant professor of medicine in the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Aaron S Kesselheim
- Aaron S. Kesselheim is a professor of medicine and the director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School
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19
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Boesen K, Simonsen AL, Jørgensen KJ, Gøtzsche PC. Cross-sectional study of medical advertisements in a national general medical journal: evidence, cost, and safe use of advertised versus comparative drugs. Res Integr Peer Rev 2021; 6:8. [PMID: 33971984 PMCID: PMC8108346 DOI: 10.1186/s41073-021-00111-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/11/2021] [Indexed: 01/15/2023] Open
Abstract
Background Healthcare professionals are exposed to advertisements for prescription drugs in medical journals. Such advertisements may increase prescriptions of new drugs at the expense of older treatments even when they have no added benefits, are more harmful, and are more expensive. The publication of medical advertisements therefore raises ethical questions related to editorial integrity. Methods We conducted a descriptive cross-sectional study of all medical advertisements published in the Journal of the Danish Medical Association in 2015. Drugs advertised 6 times or more were compared with older comparators: (1) comparative evidence of added benefit; (2) Defined Daily Dose cost; (3) regulatory safety announcements; and (4) completed and ongoing post-marketing studies 3 years after advertising. Results We found 158 medical advertisements for 35 prescription drugs published in 24 issues during 2015, with a median of 7 advertisements per issue (range 0 to 11). Four drug groups and 5 single drugs were advertised 6 times or more, for a total of 10 indications, and we made 14 comparisons with older treatments. We found: (1) ‘no added benefit’ in 4 (29%) of 14 comparisons, ‘uncertain benefits’ in 7 (50%), and ‘no evidence’ in 3 (21%) comparisons. In no comparison did we find evidence of ‘substantial added benefit’ for the new drug; (2) advertised drugs were 2 to 196 times (median 6) more expensive per Defined Daily Dose; (3) 11 safety announcements for five advertised drugs were issued compared to one announcement for one comparator drug; (4) 20 post-marketing studies (7 completed, 13 ongoing) were requested for the advertised drugs versus 10 studies (4 completed, 6 ongoing) for the comparator drugs, and 7 studies (2 completed, 5 ongoing) assessed both an advertised and a comparator drug at 3 year follow-up. Conclusions and relevance In this cross-sectional study of medical advertisements published in the Journal of the Danish Medical Association during 2015, the most advertised drugs did not have documented substantial added benefits over older treatments, whereas they were substantially more expensive. From January 2021, the Journal of the Danish Medical Association no longer publishes medical advertisements. Supplementary Information The online version contains supplementary material available at 10.1186/s41073-021-00111-9.
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Affiliation(s)
- Kim Boesen
- Nordic Cochrane Centre, Rigshospitalet Dept. 7811, 2100 Copenhagen, Denmark. .,Current address: Meta Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Charité Universitätsmedizin, QUEST Center for Transforming Biomedical Research, Berlin, Germany.
| | | | - Karsten Juhl Jørgensen
- Nordic Cochrane Centre, Rigshospitalet Dept. 7811, 2100 Copenhagen, Denmark.,Centre for Evidence-Based Medicine (CEBMO) and Cochrane Denmark, Dept. Clinical Research, University of Southern Denmark, Odense, Denmark.,Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
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20
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San-Juan-Rodriguez A, Gellad WF, Shrank WH, Good CB, Hernandez I. A decade of increases in Medicare Part B pharmaceutical spending: what are the drivers? J Manag Care Spec Pharm 2021; 27:565-573. [PMID: 33908276 DOI: 10.18553/jmcp.2021.27.5.565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Medicare Part B pharmaceutical spending has increased rapidly, more than doubling in 2006-2017. Yet, it is unclear whether this increase was driven by increased utilization or increased cost per claim. OBJECTIVE: To evaluate the relative impact of changes in drug utilization and cost per claim on changes in Medicare Part B pharmaceutical spending in 2008-2016 overall, by drug type (specialty and nonspecialty) and therapeutic category. METHODS: In this retrospective descriptive study, we extracted all claims in 2008-2016 for separately payable Part B drugs from a 5% random sample of Medicare beneficiaries. Our study included 3 outcomes calculated annually for all included drugs: (1) spending, defined as the sum of total payments; (2) utilization, defined as total number of claims; and (3) cost per claim, defined as spending divided by the number of claims. Estimates of spending and utilization were expressed per beneficiary-year. Spending and cost per claim were adjusted for inflation. For each outcome, we calculated relative changes in 2008-2016. We repeated analyses stratifying by drug type (specialty and nonspecialty) and therapeutic class. RESULTS: Pharmaceutical spending in Medicare Part B increased by 34% from 2008-2016, driven by a 53% increase in the cost per claim. Utilization decreased by 12%. Spending on specialty drugs increased by 56%, driven by a 48% increase in the cost per claim and a 6% utilization increase. Spending on nonspecialty drugs decreased by 32% driven by an 18% reduction in the cost per claim and a 17% reduction in utilization. Spending on ophthalmic preparations increased by 281%, driven by a 238% utilization increase and a 13% increase in the cost per claim. Spending on antiarthritic and immunologic agents increased by 159%, driven by a 117% increase in the cost per claim and a 19% utilization increase. CONCLUSIONS: Medicare Part B pharmaceutical spending grew in recent years, despite decreased utilization, driven by an overall increase in the cost per claim. This was a product of rising drug prices and increased utilization of more expensive specialty drugs. These findings support the development of policies that aim to spur competition and control price growth of provider-administered drugs. DISCLOSURES: The authors acknowledge funding from the Myers Family Foundation. Hernandez was funded by the National Heart, Lung and Blood Institute (grant number K01HL142847). Shrank is an employee of Humana. Good is an employee of the UPMC Health Plan Insurance Services Division. There are no other potential conflicts of interest to disclose.
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Affiliation(s)
- Alvaro San-Juan-Rodriguez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
| | - Walid F Gellad
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | - Chester B Good
- Insurance Services Division, UPMC Health Plan, Pittsburgh, PA
| | - Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA
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21
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Affiliation(s)
- Michelle M Mello
- Stanford Law School, Stanford, California
- Stanford Health Policy and the Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Trish Riley
- National Academy for State Health Policy, Portland, Maine
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22
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Shao H, Laxy M, Benoit SR, Cheng YJ, Gregg EW, Zhang P. Trends in Total and Out-of-pocket Payments for Noninsulin Glucose-Lowering Drugs Among U.S. Adults With Large-Employer Private Health Insurance From 2005 to 2018. Diabetes Care 2021; 44:925-934. [PMID: 33563653 DOI: 10.2337/dc20-2871] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/10/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate trends in total payment and patients' out-of-pocket (OOP) payments of noninsulin glucose-lowering drugs by class from 2005 to 2018. RESEARCH DESIGN AND METHODS We analyzed data for 53 million prescriptions from adults aged >18 years with type 2 diabetes under fee-for-service plans from the 2005-2018 IBM MarketScan Commercial Databases. The total payment was measured as the amount that the pharmacy received, and the OOP payment was the sum of copay, coinsurance, and deductible paid by the beneficiaries. We applied a joinpoint regression to evaluate nonlinear trends in cost between 2005 and 2018. We further conducted a decomposition analysis to explore the drivers for total payment change. RESULTS Total annual payments for older drug classes, including metformin, sulfonylurea, meglitinide, α-glucosidase inhibitors, and thiazolidinedione, declined during 2005-2018, ranging from -$271 (-53.8%) for metformin to -$2,406 (-92.2%) for thiazolidinedione. OOP payments for these drug classes also reduced. In the same period, the total annual payments for the newer drug classes, including dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors, increased by $2,181 (88.4%), $3,721 (77.6%), and $1,374 (37.0%), respectively. OOP payment for these newer classes remained relatively unchanged. Our study findings indicate that switching toward the newer classes for noninsulin glucose-lowering drugs was the main driver that explained the total payment increase. CONCLUSIONS Average annual payments and OOP payment for noninsulin glucose-lowering drugs increased significantly from 2005 to 2018. The uptake of newer drug classes was the main driver.
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Affiliation(s)
- Hui Shao
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA .,Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Michael Laxy
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Munich, Germany
| | - Stephen R Benoit
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Yiling J Cheng
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,School of Public Health, Epidemiology and Biostatistics, Imperial College London, London, U.K
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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23
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Mello MM, Riley T. To Address Drug Affordability, Grab the Low-Hanging Fruit. JAMA HEALTH FORUM 2021; 2:e210260. [DOI: 10.1001/jamahealthforum.2021.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michelle M. Mello
- Stanford Law School, Stanford, California
- Stanford Heath Policy and the Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Trish Riley
- National Academy for State Health Policy, Portland, Maine
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24
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Zhou B, Zissimopoulos J, Nadeem H, Crane MA, Goldman D, Romley JA. Association between exenatide use and incidence of Alzheimer's disease. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12139. [PMID: 33614900 PMCID: PMC7882542 DOI: 10.1002/trc2.12139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Recent developments suggest that insulin-sensitizing agents used to treat type II diabetes (T2DM) may also prove useful in reducing the risk of Alzheimer's disease (AD). The objective of this study is to analyze the association between exenatide use among Medicare beneficiaries with T2DM and the incidence of AD. METHODS We performed a retrospective cohort analysis on claims data from a 20% random sample of Medicare beneficiaries with T2DM from 2007 to 2013 (n = 342,608). We compared rates of incident AD between 2009 and 2013 according to exenatide use in 2007-2008, measured by the number of 30-day-equivalent fills. We adjusted for demographics, comorbidities, and use of other drugs. Unmeasured confounding was assessed with an instrumental variables approach. RESULTS The sample was mostly female (65%), White (76%), and 74 years old on average. Exenatide users were more likely to be male (38% vs. 35%), White (87% vs. 76%), and younger (by 4.2 years) than non-users. Each additional 30-day-equivalent claim was associated with a 2.4% relative reduction in incidence (odds ratio 0.976; 95% confidence interval 0.963-0.989; P < .001). There was no evidence of unmeasured confounding. DISCUSSION Exenatide use is associated with a reduced incidence of AD among Medicare beneficiaries aged 65 years or older with T2DM. The association shown in this study warrants consideration by clinicians prescribing insulin sensitizing agents to patients.
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Affiliation(s)
- Bo Zhou
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC School of PharmacyLos AngelesCaliforniaUSA
| | - Julie Zissimopoulos
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC Price School of Public PolicyLos AngelesCaliforniaUSA
| | - Hasan Nadeem
- University of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | | | - Dana Goldman
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC School of PharmacyLos AngelesCaliforniaUSA
- USC Price School of Public PolicyLos AngelesCaliforniaUSA
| | - John A. Romley
- USC Schaeffer Center for Health Policy and EconomicsLos AngelesCaliforniaUSA
- USC School of PharmacyLos AngelesCaliforniaUSA
- USC Price School of Public PolicyLos AngelesCaliforniaUSA
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25
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Shrank WH, DeParle NA, Gottlieb S, Jain SH, Orszag P, Powers BW, Wilensky GR. Health Costs And Financing: Challenges And Strategies For A New Administration. Health Aff (Millwood) 2021; 40:235-242. [DOI: 10.1377/hlthaff.2020.01560] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- William H. Shrank
- William H. Shrank is chief medical and corporate affairs officer of Humana in Louisville, Kentucky
| | - Nancy-Ann DeParle
- Nancy-Ann DeParle is a managing partner and cofounder of Consonance Capital Partners, in New York, New York
| | - Scott Gottlieb
- Scott Gottlieb is a resident fellow at the American Enterprise Institute, in Washington, D.C
| | - Sachin H. Jain
- Sachin H. Jain is president and CEO of the SCAN Group and Health Plan and an adjunct professor of medicine, Stanford University School of Medicine, in Stanford, California
| | - Peter Orszag
- Peter Orszag is the CEO of Financial Advisory at Lazard Freres and Co., LLC, in New York, New York
| | - Brian W. Powers
- Brian W. Powers is deputy chief medical officer at Humana in Boston, Massachusetts
| | - Gail R. Wilensky
- Gail R. Wilensky is a senior fellow at Project HOPE, in Bethesda, Maryland
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26
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Wolff C, Lutter R. Why are pharmacy acquisition costs and consumer prescription drug price indices apparently diverging? HEALTH ECONOMICS 2020; 29:1721-1727. [PMID: 32969080 DOI: 10.1002/hec.4165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
Pharmacy acquisition costs for prescription (Rx ) drugs have been trending below levels implied by the Bureau of Labor Statistics' (BLS) Consumer Price Index for Rx drugs, with the divergence higher when generic approvals are high. Dropping the first 6 months of generic sales from price indices calculated from pharmacy acquisition costs eliminates most of the difference between such indices and BLS indices.
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Affiliation(s)
- Carolyn Wolff
- U.S. Food and Drug Administration, Office of the Commissioner, Silver Spring, Maryland, USA
| | - Randall Lutter
- U.S. Food and Drug Administration, Office of the Commissioner, Silver Spring, Maryland, USA
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27
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Bonkowsky JL, deVeber G, Kosofsky BE. Pediatric Neurology Research in the Twenty-First Century: Status, Challenges, and Future Directions Post-COVID-19. Pediatr Neurol 2020; 113:2-12. [PMID: 32979654 DOI: 10.1016/j.pediatrneurol.2020.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND The year 2020 marked a fundamental shift in the pediatric neurology field. An impressive positive trajectory of advances in patient care and research faced sudden global disruptions by the coronavirus disease 2019 pandemic and by an international movement protesting racial, socioeconomic, and health disparities. The disruptions revealed obstacles and fragility within the pediatric neurology research mission. However, renewed commitment offers unique opportunities for the pediatric neurology research community to enhance and prioritize research directions for the coming decades. METHODS The Research Committee of the Child Neurology Society evaluated the challenges and opportunities facing the pediatric neurology research field, including reviewing published literature, synthesizing publically available data, and conducting a survey of pediatric neurologists. RESULTS We identified three priority domains for the research mission: funding levels, active guidance, and reducing disparities. Funding levels: to increase funding to match the burden of pediatric neurological disease; to tailor funding mechanisms and strategies to support clinical trial efforts unique to pediatric neurology; and to support investigators across their career trajectory. Active guidance: to optimize infrastructure and strategies, to leverage novel therapeutics, enhance data collection, and improve inclusion of children in clinical trials. Reducing disparities: to reduce health disparities in children with neurological disease, to develop proactive measures to enhance workforce diversity and inclusion, and increase avenues to balance work-life obligations for investigators. CONCLUSIONS In this uniquely challenging epoch, the pediatric neurology research community has a timely and important mission to re-engage the public and government, advancing the health of children with neurological conditions.
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Affiliation(s)
- Joshua L Bonkowsky
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah.
| | - Gabrielle deVeber
- Hospital for Sick Children Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Barry E Kosofsky
- Department of Pediatrics, New York-Presbyterian/Weill Cornell Medicine, New York, New York
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28
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Yang EJ, Galan E, Thombley R, Lin A, Seo J, Tseng CW, Resneck JS, Bach PB, Dudley RA. Changes in Drug List Prices and Amounts Paid by Patients and Insurers. JAMA Netw Open 2020; 3:e2028510. [PMID: 33295971 PMCID: PMC7726630 DOI: 10.1001/jamanetworkopen.2020.28510] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE High out-of-pocket drug costs can cause patients to skip treatment and worsen outcomes, and high insurer drug payments could increase premiums. Drug wholesale list prices have doubled in recent years. However, because of manufacturer discounts and rebates, the extent to which increases in wholesale list prices are associated with amounts paid by patients and insurers is poorly characterized. OBJECTIVE To determine whether increases in wholesale list prices are associated with increases in amounts paid by patients and insurers for branded medications. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional retrospective study analyzing pharmacy claims for patients younger than 65 years in the IBM MarketScan Commercial Database and pricing data from SSR Health, LLC, between January 1, 2010, and December 31, 2016. Pharmacy claims analyzed represent claims of employees and dependents participating in employer health benefit programs belonging to large employers. Rebate data were estimated from sales data from publicly traded companies. Analysis focused on the top 5 patent-protected specialty and 9 traditional brand-name medications with the highest total drug expenditures by commercial insurers nationwide in 2014. Data were analyzed from July 2017 to July 2020. EXPOSURES Calendar year. MAIN OUTCOMES AND MEASURES Changes in inflation-adjusted amounts paid by patients and insurers for branded medications. RESULTS In this analysis of 14.4 million pharmacy claims made by 1.8 million patients from 2010-2016, median drug wholesale list price increased by 129% (interquartile range [IQR], 78%-133%), while median insurance payments increased by 64% (IQR, 28%-120%) and out-of-pocket costs increased by 53% (IQR, 42%-82%). The mean percentage of wholesale list price accounted for by discounts increased from 17% in 2010 to 21% in 2016, and the mean percentage of wholesale list price accounted for by rebates increased from 22% in 2010 to 24% in 2016. For specialty medications, median patient out-of-pocket costs increased by 85% (IQR, 73%-88%) from 2010 to 2016 after adjustment for inflation and 42% (IQR, 25%-53%) for nonspecialty medications. During that same period, insurer payments increased by 116% for specialty medications (IQR, 100%-127%) and 28% for nonspecialty medications (IQR, 5%-34%). CONCLUSIONS AND RELEVANCE This study's findings suggest that drug list prices more than doubled over a 7-year study period. Despite rising manufacturer discounts and rebates, these price increases were associated with large increases in patient out-of-pocket costs and insurer payments.
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Affiliation(s)
- Eric J. Yang
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Emilio Galan
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Robert Thombley
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Andrew Lin
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jaeyun Seo
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Chien-Wen Tseng
- Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, Honolulu
| | - Jack S. Resneck
- Department of Dermatology, University of California, San Francisco
| | - Peter B. Bach
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York
| | - R. Adams Dudley
- School of Medicine, School of Public Health, Institute for Health Informatics, University of Minnesota, Minneapolis
- Minneapolis VA Medical Center, Minneapolis, Minnesota
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29
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Bhat S, Derington CG, Trinkley KE. Clinicians' Values and Preferences for Medication Adherence and Cost Clinical Decision Support in Primary Care: A Qualitative Study. Appl Clin Inform 2020; 11:405-414. [PMID: 32492717 DOI: 10.1055/s-0040-1712467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Medication nonadherence and unaffordability are prevalent, burdensome issues in primary care. In response, technology companies are capitalizing on clinical decision support (CDS) to deliver patient-specific information regarding medication adherence and costs to clinicians using electronic health records (EHRs). To maximize adoption and usability, these CDS tools should be designed with consideration of end users' values and preferences. OBJECTIVE This article evaluates primary care clinicians' values and preferences for a medication adherence and cost CDS. METHODS We conducted semistructured interviews with primary care clinicians with prescribing privileges and EHR access to identify clinicians' perceptions of and approaches to assessing medication adherence and costs, and to determine perceived values and preferences for medication adherence and cost CDS. Interviews were conducted until saturation of responses was reached. ATLAS.ti was used for thematic analysis. RESULTS Among 26 clinicians interviewed, themes identified included a high value, but moderate need for a medication adherence CDS and high value and need for cost CDS. Clinicians expressed the cost CDS would provide actionable solutions and greatly impact patient care. Another theme identified was a desire for medication adherence and cost CDS to be separate tools yet integrated into workflow. The majority of clinicians preferred a medication adherence CDS that integrated claims data and actively displayed data using color-coded adherence categories within patients' medication lists in the EHR. For the cost CDS, clinicians preferred medication out-of-pocket costs and a list of cheaper or payor-preferred alternatives to display within the order queue of the EHR. CONCLUSION We identified valuable insights regarding clinician values and preferences for medication adherence and cost CDS. Overall, primary care clinicians feel CDS for medication adherence and cost are valuable and prefer them to be separate. These insights should be used to inform the design, implementation, and EHR integration of future medication and cost CDS tools.
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Affiliation(s)
- Shubha Bhat
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States
| | - Catherine Grace Derington
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States.,Department of Pharmacy, Kaiser Permanente Colorado, Aurora, Colorado, United States
| | - Katy E Trinkley
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, United States.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
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30
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Conti R, Dusetzina SB, Sachs R. How The ACA Reframed The Prescription Drug Market And Set The Stage For Current Reform Efforts. Health Aff (Millwood) 2020; 39:445-452. [PMID: 32119622 DOI: 10.1377/hlthaff.2019.01432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act contained a range of provisions that altered prescription drug access and affordability for patients, payers, and providers. Yet the act stopped short of instituting systemic changes in the pricing of drugs, in part to address concerns that more fundamental changes might disrupt the development of new medicines. Looking back a decade after the Affordable Care Act became law, we found that new drug approvals have accelerated and the therapeutic advances embodied in some novel medicines are substantial-as are the prices that companies are charging for them. The lack of affordability of prescription drugs has become an increasing challenge for American patients and payers, particularly those with limited budgets. In this article we consider how things have changed in the past decade and how missed opportunities in the Affordable Care Act's passage figure prominently in the current drug pricing debate.
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Affiliation(s)
- Rena Conti
- Rena Conti ( rconti@bu. edu ) is an associate professor in the Department of Markets, Public Policy, and Law at Boston University Questrom School of Business and associate research director of Biopharma and Public Policy for the Boston University Institute for Health System Innovation and Policy, in Massachusetts
| | - Stacie B Dusetzina
- Stacie B. Dusetzina is an associate professor of health policy and the Ingram Associate Professor of Cancer Research at Vanderbilt University School of Medicine, in Nashville, Tennessee
| | - Rachel Sachs
- Rachel Sachs is an associate professor of law at the Washington University School of Law, in St. Louis, Missouri
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31
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Hernandez I, San-Juan-Rodriguez A, Good CB, Gellad WF. Changes in List Prices, Net Prices, and Discounts for Branded Drugs in the US, 2007-2018. JAMA 2020; 323:854-862. [PMID: 32125403 PMCID: PMC7054846 DOI: 10.1001/jama.2020.1012] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Most studies that have examined drug prices have focused on list prices, without accounting for manufacturer rebates and other discounts, which have substantially increased in the last decade. OBJECTIVE To describe changes in list prices, net prices, and discounts for branded pharmaceutical products for which US sales are reported by publicly traded companies, and to determine the extent to which list price increases were offset by increases in discounts. DESIGN, SETTING, AND PARTICIPANTS Retrospective descriptive study using 2007-2018 pricing data from the investment firm SSR Health for branded products available before January 2007 with US sales reported by publicly traded companies (n = 602 drugs). Net prices were estimated by compiling company-reported sales for each product and number of units sold in the US. EXPOSURES Calendar year. MAIN OUTCOMES AND MEASURES Outcomes included list and net prices and discounts in Medicaid and other payers. List prices represent manufacturers' price to wholesalers or direct purchasers but do not account for discounts. Net prices represent revenue per unit of the product after all manufacturer concessions are accounted for (including rebates, coupon cards, and any other discount). Means of outcomes were calculated each year for the overall sample and 6 therapeutic classes, weighting each product by utilization and adjusting for inflation. RESULTS From 2007 to 2018, list prices increased by 159% (95% CI, 137%-181%), or 9.1% per year, while net prices increased by 60% (95% CI, 36%-84%), or 4.5% per year, with stable net prices between 2015 and 2018. Discounts increased from 40% to 76% in Medicaid and from 23% to 51% for other payers. Increases in discounts offset 62% of list price increases. There was large variability across classes. Multiple sclerosis treatments (n = 4) had the greatest increases in list (439%) and net (157%) prices. List prices of lipid-lowering agents (n = 11) increased by 278% and net prices by 95%. List prices of tumor necrosis factor inhibitors (n = 3) increased by 166% and net prices by 73%. List prices of insulins (n = 7) increased by 262%, and net prices by 51%. List prices of noninsulin antidiabetic agents (n = 10) increased by 165%, and net prices decreased by 1%. List price increases were lowest (59%) for antineoplastic agents (n = 44), but discounts only offset 41% of list price increases, leading to 35% increase in net prices. CONCLUSIONS AND RELEVANCE In this analysis of branded drugs in the US from 2007 to 2018, mean increases in list and net prices were substantial, although discounts offset an estimated 62% of list price increases with substantial variation across classes.
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Affiliation(s)
- Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alvaro San-Juan-Rodriguez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chester B. Good
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Insurance Services Division, UPMC Health Plan, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Walid F. Gellad
- Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Abstract
Objective: To review specific literature that aimed to predict the future of US pharmacy, beginning in the late 1980s. Data Sources: Articles were identified from searching MEDLINE, CINAHL, Google Scholar, and references of relevant articles. The following combinations of search terms were used: future, pharmacy, prediction, and forecast. Study Selection and Data Extraction: The following inclusion criteria were applied: (1) full-text commentary, review, or original research and (2) focused predominantly on the pharmacy in the United States. Data on predictions for the future of pharmacy were extracted. Data Synthesis: We selected 3 articles published between 1988 and 2006, with each aiming to project the future for the following decade. We examined each prediction in light of the current knowledge. Relevance to Patient Care and Clinical Practice: Educators, practitioners, and other stakeholders should consider reflecting on the changes in pharmacy for the past 3 decades and applying both historical and emerging trends to improve patient care and sustain practice in the third decade of the 21st century and beyond. Conclusion: Most of the predictions for the future of pharmacy from the past 3 decades materialized, with some still in progress (reimbursement for pharmacy services), whereas others manifested in unexpected ways (transition from shortage to excess of pharmacists). Current forces shaping pharmacy include, but are not limited to, growing spending and use of specialty drugs, automation of pharmacy operations, growth of pharmacy in the digital health enterprise, and growing consumer interest in the use of analytical pharmacy that tests drugs before dispensing.
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Crowley R, Daniel H, Cooney TG, Engel LS. Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care. Ann Intern Med 2020; 172:S7-S32. [PMID: 31958805 DOI: 10.7326/m19-2415] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This paper is part of the American College of Physicians' policy framework to achieve a vision for a better health care system, where everyone has coverage for and access to the care they need, at a cost they and the country can afford. Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage. The nation's existing health care system is inefficient, unaffordable, unsustainable, and inaccessible to many. Part 1 of this paper discusses why the United States needs to do better in addressing coverage and cost. Part 2 presents 2 potential approaches, a single-payer model and a public choice model, to achieve universal coverage. Part 3 describes how an emphasis on value-based care can reduce costs.
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Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C., H.D.)
| | - Hilary Daniel
- American College of Physicians, Washington, DC (R.C., H.D.)
| | - Thomas G Cooney
- Oregon Health & Science University and Portland Veterans Affairs Medical Center, Portland, Oregon (T.G.C.)
| | - Lee S Engel
- Louisiana State University Health Sciences Center, New Orleans, Louisiana (L.S.E.)
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Klonoff DC, Gabbay RA, Kerr D. Barriers and Solutions to a Recently Noted Failure of Diabetes Care Outcomes to Improve From 2005 to 2016 in the United States. J Diabetes Sci Technol 2020; 14:189-190. [PMID: 31595785 PMCID: PMC7189157 DOI: 10.1177/1932296819880861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David C. Klonoff
- Mills-Peninsula Medical Center, San
Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCPE,
Mills-Peninsula Medical Center, 100 South San Mateo Drive, Room 5147, San Mateo,
CA 94401, USA.
| | | | - David Kerr
- Sansum Diabetes Research Institute,
Santa Barbara, CA, USA
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San-Juan-Rodriguez A, Good CB, Heyman RA, Parekh N, Shrank WH, Hernandez I. Trends in Prices, Market Share, and Spending on Self-administered Disease-Modifying Therapies for Multiple Sclerosis in Medicare Part D. JAMA Neurol 2019; 76:1386-1390. [PMID: 31449293 DOI: 10.1001/jamaneurol.2019.2711] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Before 2009, only 4 self-administered disease-modifying therapies (DMTs) were approved for the treatment of multiple sclerosis (MS). Since then, 7 new agents have entered the market. Objective To assess trends in prices, market share, and spending on self-administered DMTs for MS in Medicare Part D from 2006 through 2016. Design, Setting, and Participants This cohort study used claims data from 2006 through 2016 from a 5% random sample of Medicare beneficiaries (a mean of 2.8 million Medicare beneficiaries per year). All prescription claims for self-administered DMTs for MS (glatiramer acetate, interferon beta-1a, interferon beta-1b, fingolimod hydrochloride, teriflunomide, dimethyl fumarate, and peginterferon beta-1a) were extracted throughout the study period. Main Outcomes and Measures The main outcomes were the annual cost of treatment with each medication, based on Medicare Part D prescription claims gross costs and US Food and Drug Administration-approved recommended dosing; market share of each medication, defined as the proportion of pharmaceutical spending accounted by every drug; and pharmaceutical spending per 1000 Medicare beneficiaries for all drugs. The relative contributions of Medicare Part D Plans' payments, Medicare catastrophic coverage payments, low-income cost-sharing subsidies, patients' out-of-pocket costs, manufacturers' coverage gap discounts, and other payments toward pharmaceutical spending were further quantified. Results Annual costs of treatment with self-administered DMTs for MS more than quadrupled from 2006 to 2016, from a mean (SD) of $18 660 ($1177) to $75 847 ($16 956) and at a mean rate of 12.8% every year. Brand-name glatiramers accounted for the largest market share across the study period, ranging between $25 552 of $79 411 per 1000 Medicare beneficiaries (32.2%) and $10 342 of $21 365 per 1000 Medicare beneficiaries (48.4%). Platform therapies experienced a substantial drop from 2006 to 2016 in favor of newer therapies, with decreases in the market shares of brand-name glatiramers (per 1000 Medicare beneficiaries: $2861 of $7794 [36.7%] to $25 552 of $79 411 [32.2%]), interferon beta-1a (30 µg; per 1000 Medicare beneficiaries: $2521 of $7794 [32.3%] to $11 298 of $79 411 [14.2%]), interferon beta-1b (Betaseron; per 1000 Medicare beneficiaries: $1460 of $7794 [18.7%] to $3588 of $79 411 [4.5%]), and interferon beta-1a (8.8/22/44 µg; per 1000 Medicare beneficiaries: $951 of $7794 [12.2%] to $6588 of $79 411 [8.3%]) and increases in fingolimod (to $6311 of $79 411 per 1000 Medicare beneficiaries [7.9%]), teriflunomide (to $7177 of $79 411 per 1000 Medicare beneficiaries [9.0%]), and dimethyl fumarate (to $15 262 of $79 411 per 1000 Medicare beneficiaries [19.2%]). Throughout the study period, pharmaceutical spending per 1000 beneficiaries increased 10.2-fold (from $7794 to $79 411), and out-of-pocket patient spending per 1000 beneficiaries increased 7.2-fold (from $372 to $2673). The relative contribution of federal payments toward pharmaceutical spending increased from $5335 of $7794 (68.5%) to $58 620 to $79 411 (73.8%). Conclusions and Relevance Per this analysis, prices of self-administered DMTs for MS increased dramatically between 2006 and 2016. This resulted in a 7.2-fold increase in patient out-of-pocket costs.
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Affiliation(s)
- Alvaro San-Juan-Rodriguez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Chester B Good
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for High-Value Health Care, Insurance Services Division, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Rock A Heyman
- Department of Neurology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Multiple Sclerosis Center, UPMC Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Natasha Parekh
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for High-Value Health Care, Insurance Services Division, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - William H Shrank
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.,Center for High-Value Health Care, Insurance Services Division, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Selden TM, Abdus S, Miller GE. Decomposing changes in the growth of U.S. prescription drug use and expenditures, 1999-2016. Health Serv Res 2019; 54:752-763. [PMID: 31070264 DOI: 10.1111/1475-6773.13164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyze factors associated with changes in prescription drug use and expenditures in the United States from 1999 to 2016, a period of rapid growth, deceleration, and resumed above-average growth. DATA SOURCES/STUDY SETTING The Medical Expenditure Panel Survey (MEPS), containing household and pharmacy information on over five million prescription drug fills. STUDY DESIGN We use nonparametric decomposition to analyze drug use, average payment per fill, and per capita expenditure, tracking the contributions over time of socioeconomic characteristics, health status and treated conditions, insurance coverage, and market factors surrounding the patent cycle. DATA COLLECTION/EXTRACTION METHODS Medical Expenditure Panel Survey data were combined with information on drug approval dates and patent status. PRINCIPAL FINDINGS Per capita utilization increased by nearly half during 1999-2016, with changes in health status and treated conditions accounting for four-fifths of the increase. In contrast, per capita expenditures more than doubled, with individual characteristics only explaining one-third of the change. Other drivers of spending during this period include the changing pipeline of new drugs, drugs losing exclusivity, and changes in generic competition. CONCLUSIONS Long-term trends in treated conditions were the fundamental drivers of medication use, whereas factors involving the patent cycle accelerated and decelerated spending growth relative to trends in use.
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Affiliation(s)
- Thomas M Selden
- Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Salam Abdus
- Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
| | - G Edward Miller
- Division of Research and Modeling, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Maryland
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