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Chi W, Song J, Yazdanfard S, Daggolu J, Varisco TJ. Why the increase? Examining the rise in prescription medication expenditures in the United States between 2011 and 2020. Res Social Adm Pharm 2024; 20:432-442. [PMID: 38302297 DOI: 10.1016/j.sapharm.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
The objective of this cross-sectional analysis was to identify determinants of increasing medicine expenditures in the US between 2011 and 2020. Prescription medication expenditures from the 2011-2020 Medical Expenditures Panel Survey (MEPS) were used to calculate total annual medication expenditures by payer categories (Out-of-pocket, Medicare, Medicaid, TRICARE/Veterans Administration/CHAMPVA (TVAC), Other Government Sources, Private Insurance, and Other Sources). From here, expenditures were stratified by therapeutic category using Multum Lexicon Drug Class to examine trends in expenditures by therapeutic area. Linear regression was used to identify temporal trends in medication expenditures. From 2011 to 2020, total annual prescription medication expenditures rose from $341.49 to $473.12 billion per year with metabolic agents being the most costly category. Among the metabolic agents, antidiabetic agents were the most costly therapeutic area, with an increasing trend observed from $27.15 to $89.17 billion over the same period. Medicare, Medicaid, Private Insurance, TVAC, and Other Sources also saw an increasing trend in antidiabetic agent expenditure, while no trend was observed for Out-of-pocket and Other Government Sources. Insulin had the highest expenditure among antidiabetic agents. Further studies are warranted to explore specific factors contributing to the increasing trend.
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Affiliation(s)
- Whanhui Chi
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, USA
| | - Juhyeon Song
- Hobby School of Public Affairs, University of Houston, USA
| | - Sahar Yazdanfard
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, USA
| | - Jerusha Daggolu
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, USA
| | - Tyler J Varisco
- The Prescription Drug Misuse Education and Research Center, Department of Pharmaceutical Health Outcomes and Policy University of Houston College of Pharmacy, USA.
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Li C, Zhu J, Shan L, Zhou Y, Liu G, Zhu H, Wu Q, Cui Y, Kang Z. Impact of medical insurance access negotiation on the utilization of innovative anticancer drugs in China: an interrupted time series analysis. BMC Health Serv Res 2024; 24:90. [PMID: 38233857 PMCID: PMC10792910 DOI: 10.1186/s12913-023-10393-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The high costs of innovative anticancer drugs hinder a number of cancer patients' access to these drugs in China. To address this problem, in 2018, the medical insurance access negotiation (MIAN) policy was implemented, when the prices of 17 innovative anticancer drugs were successfully negotiated and they were therefore included in the reimbursement list. This study aimed to explore the impact of the MIAN policy on the utilization of innovative anticancer drugs. METHODS With monthly data on drug expenditures and defined daily doses (DDDs) of each innovative anticancer drug from January 2017 to December 2019, interrupted time series analysis was employed to estimate both the instant (change in the level of outcome) and long-term (change in trends of outcomes) impacts of the MIAN policy on drug utilization in terms of drug expenditures and DDDs. Our sample consists of 12 innovative anticancer drugs. RESULTS From January 2017 to December 2019, the monthly drug expenditures and DDDs of 12 innovative anticancer drugs increased by about 573% (from US$8,931,809.30 to US$51,138,331.09) and 1400% (from 47,785 to 668,754), respectively. Overall, the implementation of the MIAN policy led to instant substantial increases of US$8,734,414 in drug expenditures and 158,192.5 in DDDs. Moreover, a sharper upward trend over time was reported, with increases of US$2,889,078 and 38,715.3 in the monthly growth rates of drug expenditures and DDDs, respectively. Regarding individual innovative anticancer drugs, the most prominent instant change and trend change in drug utilization were found for osimertinib, crizotinib, and ibrutinib. In contrast, the utilization of pegaspargase was barely affected by the MIAN policy. CONCLUSIONS The MIAN policy has effectively promoted the utilization of innovative anticancer drugs. To ensure the continuity of the effects and eliminate differentiation, supplementary measures should be carried out, such as careful selection of drugs for medical insurance negotiations, a health technology assessment system and a multichannel financing mechanism.
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Affiliation(s)
- Cui Li
- Department of Social Medicine, School of Health Management, Harbin Medical University, Heilongjiang, China
- Department of Material management, Fourth Affiliated Hospital, Harbin Medical University, Heilongjiang, China
| | - Jingmin Zhu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Heilongjiang, China
- Department of Epidemiology and Public Health, University College London, London, UK
- Centre for Health Economics and Policy Innovation, Department of Economics and Public Policy, Imperial Business School, London, UK
| | - Linghan Shan
- Department of Social Medicine, School of Health Management, Harbin Medical University, Heilongjiang, China
| | - Yingyu Zhou
- Science and Technology Development Center of the Chinese Pharmaceutical Association, Peking, China
| | - Gang Liu
- Department of Acupuncture, Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Hong Zhu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Heilongjiang, China
- Department of Pharmaceutical Administration, School of Humanities and Social Sciences, Harbin Medical University, Heilongjiang, China
| | - Qunhong Wu
- Department of Social Medicine, School of Health Management, Harbin Medical University, Heilongjiang, China.
| | - Yu Cui
- Department of Social Medicine, School of Health Management, Harbin Medical University, Heilongjiang, China.
| | - Zheng Kang
- Department of Social Medicine, School of Health Management, Harbin Medical University, Heilongjiang, China
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Cromie D, Mullan F, Hinchliff C, Miller M, McVerry F, McCarron MO. Secular trends in disease modifying treatment and expenditure in multiple sclerosis: A longitudinal population study in the north of Ireland. Mult Scler Relat Disord 2020; 45:102444. [PMID: 32799123 DOI: 10.1016/j.msard.2020.102444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/18/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The epidemiology of multiple sclerosis (MS) is important for planning disease modifying therapy (DMT). Secular changes in the use of DMT in MS can guide future service development. METHODS A population study of the prevalence of multiple sclerosis was completed in the west of Northern Ireland - a defined geographic area making up the Western Health and Social Care Trust (WHSCT). The use, category and cost of DMT for the MS population in the WHSCT were measured over 11 years. RESULTS The WHSCT had a recorded prevalence of MS of 238.4/100,000 (95%CI 221.5-256.5) in 2018. DMT use increased over threefold in 11 years. Four hundred and nine (57%) of 720 MS patients were taking a DMT by 2018. The annual expenditure of DMT drugs had increased sixfold over ten years to £5,301,198 in 2018 (using 2018 prices), reflecting both an increase in DMT use and a switch to more intensive DMTs. Younger MS patients were more likely to be taking a DMT (P<0.001). CONCLUSION DMT use and cost have been increasing among the MS population in the Northern Ireland. There has been a temporal switch to more efficacious DMTs. Future research should monitor the cost-effectiveness and equity of treatment of MS patients.
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Affiliation(s)
- David Cromie
- Department of Neurology (FM, CH, MM, FMV, MMC) and Medicine, Altnagelvin Hospital, Derry, BT47 6SB, N. Ireland, UK
| | - Fiona Mullan
- Department of Neurology (FM, CH, MM, FMV, MMC) and Medicine, Altnagelvin Hospital, Derry, BT47 6SB, N. Ireland, UK
| | - Carole Hinchliff
- Department of Neurology (FM, CH, MM, FMV, MMC) and Medicine, Altnagelvin Hospital, Derry, BT47 6SB, N. Ireland, UK
| | - Megan Miller
- Department of Neurology (FM, CH, MM, FMV, MMC) and Medicine, Altnagelvin Hospital, Derry, BT47 6SB, N. Ireland, UK
| | - Ferghal McVerry
- Department of Neurology (FM, CH, MM, FMV, MMC) and Medicine, Altnagelvin Hospital, Derry, BT47 6SB, N. Ireland, UK
| | - Mark Owen McCarron
- Department of Neurology (FM, CH, MM, FMV, MMC) and Medicine, Altnagelvin Hospital, Derry, BT47 6SB, N. Ireland, UK.
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Amiresmaili M, Emrani Z. Studying the impoverishing effects of procuring medicines: a national study. BMC Int Health Hum Rights 2019; 19:23. [PMID: 31366400 PMCID: PMC6670235 DOI: 10.1186/s12914-019-0210-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 07/24/2019] [Indexed: 11/17/2022]
Abstract
Background One of the main treatment procedures is through medicine prescription. Considering the rising burden of drug costs, we conducted this study to estimate the impoverishing effects of medicine on Iranian households. Method We carried out calculations based on the Iranian National Household Survey for the year 2013. Amoxicillin, atorvastatin and metformin were the drugs selected. Three different poverty lines were applied. Impoverishment was estimated for various scenarios. Additionally, the associations of some demographic factors were tested. Excel 2013 and SPSS v.19 were used. Results Many households fell under the poverty line after purchasing drugs. Procuring original brand (OB) drugs caused more poverty than lowest-priced generic (LPG) equivalents. The logistic regression testing showed that the age, gender and literacy of the head of household and the size of the household were associated with impoverishment. Conclusion This study showed that purchasing medicines increases the impoverishment risk of households. This risk is an index used to assess financial protection against health costs, which is in turn an indicator of health equity. The results will be of practical use for policymakers when addressing different scenarios of setting medicines prices as well as when considering alternatives for cost shifting for cross subsidies in pharmaceutical procurement.
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Affiliation(s)
- Mohammadreza Amiresmaili
- Department of Health Management, Economics and Policy Making, School of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Zahra Emrani
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. .,Health Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Lomnicky Y, Kurnik D, Loebstein R, Katzir I, Vesterman-Landes J, Siegelmann-Danieli N. Trends in annual drug expenditure - a 16 year perspective of a public healthcare maintenance organization. Isr J Health Policy Res 2016; 5:37. [PMID: 27651890 DOI: 10.1186/s13584-016-0096-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/08/2016] [Indexed: 11/26/2022] Open
Abstract
Background Modern drug therapy accounts for a major share of health expenditure and challenges public provider resources. The objective of our study was to compare drug expenditure trends for ten major drug classes over 16 years at Maccabi Healthcare Services (MHS), the 2nd largest healthcare organization in Israel. Methods A retrospective analysis of drug expenditure per HMO beneficiary between the years 1998–2014. Trends in annual mean drug expenditures per MHS member were compared among 10 major drug classes. Results Average annual drug expenditure per beneficiary increased during the study period from 429.56 to 474.32 in 2014 (10.4 %). Ten drug classes accounted for 58.0 % and 77.8 % of total drug cost in 1998 and 2014, respectively. The overall distribution of drug expenditure among drug classes differed significantly between 1998 and 2014 (p < 0.001), mainly due to the increase in expenditure for cancer drugs, from 6.8 % of total drug cost to 30.3 %. In contrast, expenditures for cardiovascular drugs decreased during the same period from 16.0 to 2.7 %. Moreover, the median annual increase in net drug costs per HMO member during 1998–2014 was largest for cancer drugs (NIS 6.18/year; IQR, 1.70–9.92/year), about two-fold that of immunosuppressants, the second fastest growing drug class (NIS 2.81; IQR, 0.58–7.43/year). Conclusions The continuous rise in anti-cancer drug expenditure puts a substantial burden on the medication budgets of public health organizations. Coordinated measures involving policy makers, physicians, and pharmaceutical companies will be required for efficient cost containment.
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Han E, Park SY, Lee EK. Assessment of the Price-Volume Agreement Program in South Korea. Health Policy 2016; 120:1209-15. [PMID: 27519975 DOI: 10.1016/j.healthpol.2016.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/15/2016] [Accepted: 07/26/2016] [Indexed: 11/24/2022]
Abstract
The Price-Volume Agreement Program (PVAP) was promulgated in 2007 in South Korea as the first attempt to adjust drug pricing according to total consumption in order to contain drug expenditure. This study was designed to assess the impact of the PVAP on diabetes drug expenditure for a period of a 10-year period (2003-2012) using claims data from the National Health Insurance Service. We estimated a multilevel mixed-effects linear regression model by comparing the level of total monthly diabetes drug expenditure for drugs subject to PVAP and existing drugs after adjusting the average differences in drug expenditure before and after the PVAP. The monthly total expenditure for drugs that were newly listed through the PVAP (negotiation drugs) was 7.03% higher on average compared to that for existing drugs, controlling for the baseline differences in expenditure before and after the PVAP. This increase was observed in all four subgroups of diabetes drugs, including sitagliptin, vildagliptin, exenatide, and others. The growth rate of total diabetes drug expenditure was reduced after the PVAP despite the sustained escalation of expenditure levels, which may imply that the PVAP has the potential to be an effective tool for drug expenditure control in the long term.
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