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Ybarra M, Weissman R. Recent Trends in Prescription Drug Launch Prices. JAMA 2022; 328:1352. [PMID: 36194225 DOI: 10.1001/jama.2022.13826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael Ybarra
- Pharmaceutical Research and Manufacturers of America (PhRMA), Washington, DC
| | - Rachel Weissman
- Pharmaceutical Research and Manufacturers of America (PhRMA), Washington, DC
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Abstract
This study uses SSR Health data on drug list prices and estimated net prices after manufacturer discounts to evaluate trends in prices for newly marketed brand-name prescription drugs in the US from 2008 to 2021.
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Affiliation(s)
- Benjamin N. Rome
- Program on Regulation, Therapeutics, and Law (PORTAL), Brigham and Women’s Hospital, Boston, Massachusetts
| | - Alexander C. Egilman
- Program on Regulation, Therapeutics, and Law (PORTAL), Brigham and Women’s Hospital, Boston, Massachusetts
| | - Aaron S. Kesselheim
- Program on Regulation, Therapeutics, and Law (PORTAL), Brigham and Women’s Hospital, Boston, Massachusetts
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Desai A, Scheckel C, Jensen CJ, Orme J, Williams C, Shah N, Leventakos K, Adjei AA. Trends in Prices of Drugs Used to Treat Metastatic Non-Small Cell Lung Cancer in the US From 2015 to 2020. JAMA Netw Open 2022; 5:e2144923. [PMID: 35076701 PMCID: PMC8790662 DOI: 10.1001/jamanetworkopen.2021.44923] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
IMPORTANCE Oncology drug prices are a determinant of health disparities in the US and worldwide. Several new therapeutic agents for non-small cell lung cancer (NSCLC) have become available on the US market over the past decade. Although increased competition typically produces lower prices, competition among brand-name oncology drugs has not resulted in lower prices. OBJECTIVE To assess price changes in class-specific brand-name medications used to treat metastatic NSCLC in the US from 2015 to 2020. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study, conducted from August 13, 2015, to August 13, 2020, used data from the Micromedex Red Book and Medi-Span Price Rx databases. The study sample was limited to 17 brand-name medications used to treat metastatic NSCLC that were available for purchase before January 1, 2019. MAIN OUTCOMES AND MEASURES The main outcomes were trends over time in average wholesale prices and wholesale acquisition cost unit prices and the correlation in price among the multiple brand-name medications within each therapeutic class (immune checkpoint inhibitors, epidermal growth factor receptor inhibitors, anaplastic lymphoma kinase inhibitors, ROS1 inhibitors, BRAF inhibitors, and MEK inhibitors), measured using the Pearson correlation coefficient. The compounded annual growth rates of different medication costs were compared with the annual inflation rate and the consumer price index for prescription drugs. RESULTS For all drug classes, the Pearson correlation coefficient approached 1.0, indicating an increase in drug list prices despite within-class drug competition. The median Pearson correlation coefficient values were 0.964 (range, 0.951-0.994) for immune checkpoint inhibitors, 0.898 (range, 0.665-0.950) for epidermal growth factor receptor inhibitors, 0.999 (range, 0.982-0.999) for anaplastic lymphoma kinase inhibitors, and 0.999 for BRAF and MEK inhibitors. The median compounded annual growth rates for most drug costs were higher than the annual inflation rate and consumer price index for prescription drugs: 1.81% (range, 1.29%-2.13%) for immune checkpoint inhibitors, 2.56% (range, 2.38%-5.26%) for epidermal growth factor receptor inhibitors, 2.46% (range, 1.75%-4.66%) for anaplastic lymphoma kinase and ROS1 inhibitors, and 3.06% (range, 0%-3.06%) for BRAF and MEK inhibitors. CONCLUSIONS AND RELEVANCE In this cross-sectional study, prices of brand-name medications for treatment of NSCLC increased in the US from 2015 to 2020 without evidence of price competition, raising concern about the affordability of promising oncology drugs. These findings suggest that drug pricing reform is needed.
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Affiliation(s)
- Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Caleb Scheckel
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Jacob Orme
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Colt Williams
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nilay Shah
- Department of Finance, Mayo Clinic, Rochester, Minnesota
| | | | - Alex A. Adjei
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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Abstract
IMPORTANCE The high and increasing expenditures for prescription medications in the US is a national problem. OBJECTIVE To explore the association of generic statin competition on relevant use and cost savings and to provide use and expenditure trends for all available statins for private and public payers and for out-of-pocket spending. DESIGN, SETTING, AND PARTICIPANTS This survey study evaluated data from the January 1, 2002, to December 31, 2018, Medical Expenditure Panel Survey by using a difference-in-differences analysis. Participants included noninstitutionalized individual statin users. Data were analyzed from November 1, 2020, to March 30, 2021. EXPOSURES The market entry of 5 generic statin medications (atorvastatin, rosuvastatin, simvastatin, lovastatin, and pravastatin). MAIN OUTCOMES AND MEASURES National- and individual-level reductions in the annual number of statin purchases and total expenditures across private insurance, public insurance (Medicaid and Medicare), and out-of-pocket spending (presented in 2018 US dollars). RESULTS Between January 1, 2002, and December 31, 2018, an average of 21.35 million statins (95% CI, 16.7-25.5 million) were purchased annually, with an average total annual cost of $24.5 billion (95% CI, $18.2-$28.8 billion). The number of brand-name statin purchases decreased by 90.9% (95% CI, 56%-98%) nationally and 27.4% (95% CI, 13%-40%) individually after the end of market exclusivity. Among major payers, the end of market exclusivity was associated with individual cost savings of $370.00 (95% CI, $430.70-$309.20) for private insurers, $281.00 (95% CI, $346.80-$215.30) for Medicare, $72.34 (95% CI, $95.22-$49.46) for Medicaid, and $211.90 (95% CI, $231.20-$192.50) for out-of-pocket spending. Combining all payers, the decrease translates to $925.60 (95% CI, $1005.00-$846.40) of annual savings per individual and $11.9 billion (95% CI, $10.9-$13.0 billion) for the US. CONCLUSIONS AND RELEVANCE Results of this survey study suggest that full generic competition of statins was associated with significant cost savings across all major payers within the US health care system.
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Affiliation(s)
- Shuo-yu Lin
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Kyle Baumann
- Department of Medicine, University of Minnesota Medical School, Minneapolis
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis
| | - Chenxuan Zhou
- School of Medicine, Virginia Commonwealth University, Richmond
| | - Weiyu Zhou
- Department of Statistics, Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - Alison Evans Cuellar
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, Virginia
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Gomes T, McCormack D, Kitchen SA, Paterson JM, Mamdani MM, Proulx L, Bayliss L, Tadrous M. Projected impact of biosimilar substitution policies on drug use and costs in Ontario, Canada: a cross-sectional time series analysis. CMAJ Open 2021; 9:E1055-E1062. [PMID: 34815261 PMCID: PMC8612652 DOI: 10.9778/cmajo.20210091] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Several Canadian provinces have introduced reimbursement policies mandating substitution of innovator biologics with lower-cost biosimilars. We estimated the number of patients affected and cost implications if such policy changes were to be implemented in Ontario, Canada. METHODS We conducted a cross-sectional time series analysis of Ontarians dispensed publicly funded biologics indicated for inflammatory diseases (rheumatic conditions, inflammatory bowel disease: infliximab, etanercept, adalimumab) between January 2018 and December 2019, and forecasted trends to Dec. 31, 2020. The primary source of data was pharmacy claims data for all biologics reimbursed by the public drug program. We modelled the number of patients affected and government expenditures (in nominal Canadian dollars) of several biosimilar policy options, including mandatory nonmedical biosimilar substitution, substitution in new users, introduction of a biosimilar for adalimumab, and price negotiations. In a secondary analysis, we included insulin glargine. RESULTS In 2018, 14 089 individuals were prescribed a publicly funded biologic for inflammatory diseases. A mandatory nonmedical biosimilar substitution would potentially have affected 7209 patients and saved $238.6 million from 2018 to 2020. A new-user substitution would have affected 757 patients and saved $34.2 million. If an adalimumab biosimilar were to become available, 12 928 patients would be affected by a mandatory nonmedical substitution and the 3-year savings would increase to $645.9 million (all biosimilars priced at 25% of innovator biologics). Finally, an expanded nonmedical substitution policy including insulin glargine would affect 115 895 patients and save $288.7 million (not including adalimumab). INTERPRETATION Policies designed to curb rising costs of biologics can have substantially different effects on patients and government expenditures. Such analyses warrant careful consideration of the balance between cost savings and effects on patients.
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Affiliation(s)
- Tara Gomes
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont.
| | - Daniel McCormack
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Sophie A Kitchen
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - J Michael Paterson
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Muhammad M Mamdani
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Laurie Proulx
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Lorraine Bayliss
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
| | - Mina Tadrous
- Unity Health Toronto and the Li Ka Shing Knowledge Institute (Gomes, Kitchen, Mamdani), St. Michael's Hospital; ICES (Gomes, McCormack, Paterson, Mamdani, Tadrous); Canada; Institute for Health Policy, Management, and Evaluation (Gomes, Paterson, Mamdani), and the Leslie Dan Faculty of Pharmacy (Gomes, Mamdani, Tadrous) at the University of Toronto, Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; Women's College Hospital (Tadrous), Ontario Drug Policy Research Network (Gomes, McCormack, Kitchen, Paterson, Mamdani, Proulx, Bayliss, Tadrous), Toronto, Ont
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Young CM, Quinn C, Trusheim MR. Durable cell and gene therapy potential patient and financial impact: US projections of product approvals, patients treated, and product revenues. Drug Discov Today 2021; 27:17-30. [PMID: 34537333 DOI: 10.1016/j.drudis.2021.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/31/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 11/17/2022]
Abstract
Durable cell and gene therapies potentially transform patient lives, but payers fear unsustainable costs arising from the more than 1000 therapies in the development pipeline. A novel multi-module Markov chain Monte Carlo-based model projects product-indication approvals, treated patients, and product revenues. We estimate a mean 63.5 (54-74 5th to 95th percentile range) cumulative US product-indication approvals through 2030, with a mean 93000 patients treated in 2030 generating a mean US$24.4 billion (US$17.0B-35.0B, US$73.0B extreme) list price product revenues not including ancillary medical costs or cost offsets. Thus, the likely dozens of durable cell and gene therapies developed through 2030 are unlikely to threaten US health system financial sustainability.
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Affiliation(s)
- Colin M Young
- MIT NEWDIGS, 77 Massachusetts Avenue, Cambridge, MA 02139-4307, USA
| | - Casey Quinn
- MIT NEWDIGS, 77 Massachusetts Avenue, Cambridge, MA 02139-4307, USA
| | - Mark R Trusheim
- MIT NEWDIGS, 77 Massachusetts Avenue, Cambridge, MA 02139-4307, USA
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Osuafor NG, Ukwe CV, Okonta M. Evaluation of availability, price, and affordability of cardiovascular, diabetes, and global medicines in Abuja, Nigeria. PLoS One 2021; 16:e0255567. [PMID: 34383799 PMCID: PMC8360378 DOI: 10.1371/journal.pone.0255567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the availability, price, and affordability of cardiovascular, diabetes, and global medicines in Abuja, Nigeria. METHODS A cross-sectional survey involving 27 private pharmacies, 13 public pharmacies, and 25 private hospital pharmacies in Abuja was conducted using the standardized World Health Organization/Health Action International methodology. The availability percentage for each pharmacy sector and each medicine was analyzed. The median price ratio (MPR) (ratio of the median price to the international reference prices) of the medicines were evaluated accordingly. Affordability was assessed by calculating the number of days' wages the lowest-paid unskilled government worker required to purchase a month worth of the standard treatment for a chronic condition. RESULTS The availability of cardiovascular (CV) medicines ranged from 28.4% (in private hospital pharmacies) to 59.9% (in private pharmacies). There was mixed variability in the mean availability of Originator Brands (OBs) and Lowest Priced Generics (LPGs) anti-diabetic drugs with the highest availability being OBs 36% and LPGs 40.2%, in private pharmacies and public pharmacies, respectively. The availability of global drugs ranged from 49.7% in private hospitals to 68.8% in private pharmacies. Two cardiovascular and four global medicines had greater than 80% availability across the pharmaceutical sectors. The median price ratio for OBs and LPGs was 9.60 and 1.72 for procurement, it was 8.08 and 2.60 in private pharmacies, 13.56 and 2.66 in public hospitals, and 16.38 and 7.89 in private hospitals. The percentage markup on LPG was 49.4% in public hospitals, 51.4% in private pharmacies, and 323% in private hospitals. Only nine medicines in both public hospitals and private pharmacies and two in the private hospital pharmacies required less than the daily wage of the lowest-paid government worker. CONCLUSION The availability of cardiovascular, diabetes, and global medicines was below 80% across the different pharmaceutical sectors in Abuja and the medicines were unaffordable. Although the prices were generally exorbitant, private pharmacies offered the best options in terms of availability, pricing, and affordability of medicines. Therefore, the results of this study emphasize the pertinence of enforcing policies that facilitate the availability, pricing, and affordability of cardiovascular, diabetes, and global medicines.
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Affiliation(s)
- Nkeiruka Grace Osuafor
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Chinwe Victoria Ukwe
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Mathew Okonta
- Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Nsukka, Nigeria
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Maqhuzu PN, Kreuter M, Bahmer T, Kahn N, Claussen M, Holle R, Schwarzkopf L. Cost drivers in the pharmacological treatment of interstitial lung disease. Respir Res 2021; 22:218. [PMID: 34344376 PMCID: PMC8335870 DOI: 10.1186/s12931-021-01807-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/17/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Treatments of interstitial lung diseases (ILDs) mainly focus on disease stabilization and relief of symptoms by managing inflammation or suppressing fibrosis by (in part costly) drugs. To highlight economic burden of drug treatment in different ILD-subtypes we assessed cost trends and therewith-associated drivers. METHODS Using data from the German, observational HILDA study we estimated adjusted mean medication costs over 36-month intervals using one- and two-part Generalized Estimating Equation (GEE) regression models with a gamma distribution and log link. Next, we determined factors associated with costs. RESULTS In Idiopathic pulmonary fibrosis (IPF) mean per capita medication costs increased from €1442 before to €11,000€ at the end of study. In non-IPF subtypes, the increase took place at much lower level. Mean per capita ILD-specific medication costs at the end of the study ranged between €487 (other ILD) and €9142 (IPF). At baseline, higher FVC %predicted values were associated with lower medication costs in IPF (-9%) and sarcoidosis (-1%). During follow up higher comorbidity burden escalated costs in progressive fibrosing ILD (PF-ILD) (+52%), sarcoidosis (+60%) and other ILDs (+24%). The effect of disease duration was not uniform, with cost savings in PF-ILD (-8%) and sarcoidosis (-6%), but increased spending in IPF (+11%). CONCLUSION Pharmacological management of ILD, in particular of IPF imposes a substantial economic burden on the healthcare system. Strategies to reduce comorbidity burden and early treatment may reduce the impact of ILDs on the healthcare system.
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Affiliation(s)
- Phillen Nozibuyiso Maqhuzu
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany.
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, and German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Thomas Bahmer
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany
- University Hospital Schleswig-Holstein Campus Kiel, Internal Medicine I, Member of the German Center for Lung Research (DZL), Arnold-Heller-Str. 3 /Haus 41a, 24105, Kiel, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Pneumology, Thoraxklinik, University of Heidelberg, and German Center for Lung Research (DZL), Röntgenstr. 1, 69126, Heidelberg, Germany
| | - Martin Claussen
- LungenClinic Grosshansdorf GmbH Pneumology, Member of the German Center for Lung Research (DZL), Wöhrendamm 80, 22927, Großhansdorf, Germany
| | - Rolf Holle
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Marchioninistr. 15, 81377, Munich, Germany
| | - Larissa Schwarzkopf
- Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ingolstaedter Landstrasse 1, 85764, Neuherberg, Germany
- Institut Fuer Therapieforschung (IFT), Leopoldstr. 175, 80804, Munich, Germany
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Lee J, Joo H, Maskery BA, Alpern JD, Park C, Weinberg M, Stauffer WM. Increases in Anti-infective Drug Prices, Subsequent Prescribing, and Outpatient Costs. JAMA Netw Open 2021; 4:e2113963. [PMID: 34143194 PMCID: PMC8214158 DOI: 10.1001/jamanetworkopen.2021.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This cross-sectional study examines the association of prices for drugs to treat hookworm and pinworm with prescribing and prescription-filling behaviors and total outpatient treatment costs.
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Affiliation(s)
- Junsoo Lee
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Department of Economics, University at Albany, State University of New York, Albany
| | - Heesoo Joo
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A. Maskery
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan D. Alpern
- Center for Global Health and Social Responsibility, Department of Medicine, University of Minnesota, Minneapolis
| | - Chanhyun Park
- Department of Pharmacy and Health Systems Science, Northeastern University, Boston, Massachusetts
- Now with Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin
| | - Michelle Weinberg
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William M. Stauffer
- Division of Global Migration and Quarantine, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Center for Global Health and Social Responsibility, Department of Medicine, University of Minnesota, Minneapolis
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Rome BN, Lee CC, Gagne JJ, Kesselheim AS. Factors Associated With Generic Drug Uptake in the United States, 2012 to 2017. Value Health 2021; 24:804-811. [PMID: 34119078 DOI: 10.1016/j.jval.2020.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/16/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES In the United States, brand-name prescription drugs remain expensive until market exclusivity ends and lower-cost generics become available. Delayed generic drug uptake may increase spending and worsen medication adherence and patient outcomes. We assessed recent trends and factors associated with generic uptake. METHODS Among 227 drugs facing new generic competition from 2012 to 2017, we used a national claims database to measure generic uptake in the first and second year after generic entry, defined as the proportion of claims for a generic version of the drug. Using linear regression, we evaluated associations between generic uptake and key drug characteristics. RESULTS Mean generic uptake was 66.1% (standard deviation 22.1%) in the first year and 82.7% (standard deviation 21.6%) in the second year after generic entry. From 2012 to 2017 generic uptake decreased 4.3% per year in the first year (95% confidence interval, 2.8%-5.8%, P < .001) and 3.2%/year in the second year (95% confidence interval, 1.2%-5.1%). Generic uptake was lower for injected than oral drugs in the first year (38.5% vs 70.0%, P < .001) and second year (50.3% vs 86.9%, P < .001). In the second year, generic uptake was higher among drugs with an authorized generic (86.1 vs 80.1%, P = .045) and those with ≥3 generic competitors (87.7% vs 78.6%, P = .055). CONCLUSION Early generic uptake decreased over the past several years. This trend may adversely affect patients and increase prescription drug spending. Policies are needed to encourage generic competition, particularly among injected drugs administered in a hospital or clinic setting.
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Affiliation(s)
- Benjamin N Rome
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - ChangWon C Lee
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Joshua J Gagne
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Abstract
Rising costs have made access to affordable insulin far more difficult for people with diabetes, especially low-income individuals, those on high deductible health plans, beneficiaries using Medicare Part B to cover insulin delivered via pump, Medicare beneficiaries in the Part D donut hole, and those who turn 26 and must transition from their parents' insurance, to manage their diabetes and avoid unnecessary complications and hospitalizations. For many patients with diabetes, insulin is a life-saving medication. Policymakers should immediately address drivers of rising insulin prices and implement solutions that would reduce high out-of-pocket expenditures for patients. The Endocrine Society recommends policy options to expand access to lower cost insulin in this paper.
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The Lancet Diabetes Endocrinology. Insulin at 100: time for action on costs. Lancet Diabetes Endocrinol 2021; 9:127. [PMID: 33607037 DOI: 10.1016/s2213-8587(21)00023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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14
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Alrasheed M, Hincapie AL, Guo JJ. Drug Expenditure, Price, and Utilization in the U.S. Medicaid: A Trend Analysis for SSRI and SNRI Antidepressants from 1991 to 2018. J Ment Health Policy Econ 2021; 24:3-11. [PMID: 33739932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND SSRIs and SNRIs are antidepressants that have largely substituted old antidepressants like Monoamine Oxidase Inhibitors (MAOIs) and Tricyclic Antidepressants (TCAs). They have been widely used since 1987 when the FDA approved the first SSRI Fluoxetine and the first SNRI Venlafaxine in 1993. Since then, several new SSRIs and SNRIs have been approved and entered the market. Utilization, pricing, and spending trends of SSRIs and SNRIs have not been analyzed yet in Medicaid. AIM To assess the trends of drug expenditure, utilization, and price of SSRI and SNRI antidepressants in the US Medicaid program, and to highlight the market share of SSRIs and SNRIs and the effect of generic drug entry on Medicaid drug expenditure. METHODS A retrospective descriptive data analysis was conducted for this study. National pharmacy summary data for study brand and generic drugs were retrieved from the Medicaid State Outpatient Drug Utilization Data. These data were collected by the US Centers for Medicare and Medicaid Services (CMS). The study period was between 1991 and 2018. Study drugs include 12 different SSRI and SNRI brands and their generics available in the market, such as citalopram, escitalopram, paroxetine, fluoxetine, sertraline, venlafaxine, desvenlafaxine, duloxetine, and levomilnacipran. Data were analyzed annually and categorized by total prescriptions (utilization), total reimbursement (spending), and cost per prescription as the proxy of the price for each drug. RESULTS From 1991 to 2018, total prescriptions of SSRI and SNRI drugs rose by 3001%. Total Medicaid spending on SSRIs and SNRIs increased from USD 64.5 million to USD 2 billion in 2004, then decreased steadily until it reached USD 755 million in 2018. The SSRIs average utilization market share was 87% compared to 13% of the SNRIs utilization market share. About 72% of total Medicaid spending on the two groups goes to SSRIs, while the remaining 28% goes to SNRIs. Brand SSRIs and SNRIs prices increased over time. On the contrary, generic drugs prices steadily decreased over time. DISCUSSION An increase in utilization and spending for both SSRI and SNRI drugs was observed. After each generic drug entered the market, utilization shifted from the brand name to the respective generic due to their lower price. These generic substitutions demonstrate a meaningful cost-containment policy for Medicaid programs. IMPLICATIONS FOR HEALTH POLICIES Our findings show the overall view of Medicaid expenditure on one of the most commonly prescribed drug classes in the US. They also provide an important insight toward the antidepressant market and the importance of monitoring different drugs and their alternatives.
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Affiliation(s)
- Marwan Alrasheed
- Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave, Cincinnati, OH 45267-0004, USA,
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15
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Abstract
This cross-sectional study examines within-class changes in US wholesale drug prices for brand-name medications from 2015 to 2020.
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Affiliation(s)
- Patrick Liu
- Yale School of Medicine, New Haven, Connecticut
| | - Sanket S. Dhruva
- Department of Medicine, School of Medicine, University of California, San Francisco
- San Francisco VA Medical Center, San Francisco, California
| | - Nilay D. Shah
- Division of Health Care Policy and Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Joseph S. Ross
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Lauriello J, Weiden PJ, Gleeson CD, Shah A, Boulanger L, Jariwala-Parikh K, Hedgeman E, O'Sullivan AK. Real-World Outcomes and Costs Following 6 Months of Treatment with the Long-Acting Injectable (LAI) Aripiprazole Lauroxil for the Treatment of Schizophrenia. CNS Drugs 2021; 35:1123-1135. [PMID: 34546558 PMCID: PMC8478765 DOI: 10.1007/s40263-021-00849-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuous antipsychotic therapy is recommended as part of long-term maintenance treatment of schizophrenia, and gaps in antipsychotic treatment have been associated with increased risks of relapse and rehospitalization. Because the use of long-acting injectable (LAI) antipsychotics may reduce the likelihood of undetected medication gaps, initiating an LAI medication may affect resource utilization and costs. The LAI aripiprazole lauroxil (AL) was approved in the United States (US) in 2015 for the treatment of schizophrenia in adults. OBJECTIVE The objective of this retrospective observational cohort study was to examine treatment patterns, resource utilization, and costs following initiation of AL for the treatment of schizophrenia in adults. METHODS A retrospective analysis of Medicaid claims data identified a cohort of patients (N = 485) starting AL shortly after Food and Drug Administration approval in October 2015. Treatment patterns, resource utilization, and costs were compared 6 months before and after treatment initiation. Subgroup analyses were conducted based on the type of antipsychotic (LAI, oral, or none) received before initiation of AL. RESULTS Over 6 months of follow-up, patients received an average of 4.6 injections out of a maximum of six (77%). After initiating AL, all-cause inpatient admissions decreased by 22.4%; other significant reductions were observed in mental health-related admissions and emergency room (ER) visits. All-cause inpatient costs decreased by an average of US$2836 per patient (p < 0.05) in the 6-month post-AL period, whereas outpatient pharmacy costs increased by US$4121 (p < 0.05), resulting in no significant difference in overall costs between the pre- and post-AL periods. The subgroup of patients who had been prescribed an oral antipsychotic before starting AL had significant reductions in proportion of patients with inpatient and ER visits and costs, but also reported a significant increase in pharmacy costs. CONCLUSIONS AL was associated with a significant reduction in inpatient costs and an increase in outpatient pharmacy costs, resulting in no changes in total healthcare costs over 6 months. The adherence rate and reductions in inpatient use may indicate the potential for greater clinical stability among patients initiated on AL compared with their previous treatment.
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Affiliation(s)
- John Lauriello
- Department of Psychiatry and Human Behavior, Jefferson Health-Sidney Kimmel Medical College, Thomas Jefferson University, 33 S 9th St, Ste 210, Philadelphia, PA, USA.
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Armstrong-Hough M, Sharma S, Kishore SP, Akiteng AR, Schwartz JI. Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis. PLoS One 2020; 15:e0241555. [PMID: 33362249 PMCID: PMC7757794 DOI: 10.1371/journal.pone.0241555] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022] Open
Abstract
Background Availability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. Methods We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. Results Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. Conclusions We conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.
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Affiliation(s)
- Mari Armstrong-Hough
- School of Global Public Health, New York University, New York, NY, United States of America
- * E-mail:
| | - Srish Sharma
- Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Sandeep P. Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Young Professionals Chronic Disease Network, New York, New York, United States of America
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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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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Yao X, Shah ND, Gersh BJ, Lopez-Jimenez F, Noseworthy PA. Assessment of Trends in Statin Therapy for Secondary Prevention of Atherosclerotic Cardiovascular Disease in US Adults From 2007 to 2016. JAMA Netw Open 2020; 3:e2025505. [PMID: 33216139 PMCID: PMC7679951 DOI: 10.1001/jamanetworkopen.2020.25505] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE Atherosclerotic cardiovascular disease (ASCVD) is highly prevalent in the US, with studies indicating substantial rates of nonadherence to and undertreatment with statin therapy. The 2013 American College of Cardiology/American Heart Association guideline recommended high-intensity statins for all patients age 75 years and younger with documented ASCVD in whom such therapy is tolerated, but there is limited evidence documenting population trends of statin use, adherence, and outcomes in the periods before and after the update to the guideline. OBJECTIVE To assess trends in the use, adherence, cost, and outcomes of statin therapy for secondary prevention in patients with different types of ASCVD between 2007 and 2016. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the OptumLab Data Warehouse database containing privately insured and Medicare Advantage enrollees with demographic characteristics similar to the national US population. Participants were adult patients (age ≥21 years) who had their first ASCVD event between January 1, 2007, and December 31, 2016. Data were characterized as belonging to 3 groups: (1) cardiovascular heart disease (CHD); (2) ischemic stroke or transient ischemic attack (TIA); and (3) peripheral artery disease (PAD). Data were analyzed from July 1 to August 1, 2018. EXPOSURES Calendar year of the initial ASCVD event. MAIN OUTCOMES AND MEASURES Trends in the statin use (within 30 days of discharge from hospitalization), adherence (proportion of days covered ≥80% within the first year), cost, major adverse cardiac events (1-year cumulative risk), and statin intolerance (within the first year). RESULTS Of the 284 954 patients with a new ASCVD event, 128 422 (45.1%) were women; the median age was 63 years (interquartile range [IQR], 54-72 years); 207 781 (72.9%) were White. The use of statins increased from 50.3% in 2007 to 59.9% in 2016, the use of high-intensity statins increased from 25.0% to 49.2%, and the adherence increased from 58.7% to 70.5% (P < .001 for all trends). Patients with CHD were more likely to receive statins and high-intensity statins and adhere to medications than patients with ischemic stroke, TIA, or PAD despite similar observed treatment benefit. In 2016, 80.9% of patients with CHD used a statin vs 65.8% of patients with ischemic stroke or TIA and 37.5% of patients with PAD. Out-of-pocket cost per 30-day decreased from a median of $20 (interquartile range, $7.6-$31.9) in 2007 to $2 (interquartile range, $1.6-$10.0) in 2016 (P < .001) with the increasing use of generic statins (42.0% in 2007 vs 94.9% in 2016; P < .001). Major adverse cardiac events decreased from 8.9% in 2007 to 6.5% in 2016 (P < .001) whereas statin intolerance increased from 4.0% to 5.1% (P < .001). CONCLUSIONS AND RELEVANCE There have been modest improvements in the use, adherence, and cardiovascular outcomes over the past decade for statin therapy in patients with ASCVD, but a substantial and persistent treatment gap exists between patients with and without CHD, between men and women.
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Affiliation(s)
- Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nilay D. Shah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- OptumLabs, Cambridge, Massachusetts
| | - Bernard J. Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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20
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Zhou X, Shrestha SS, Shao H, Zhang P. Factors Contributing to the Rising National Cost of Glucose-Lowering Medicines for Diabetes During 2005-2007 and 2015-2017. Diabetes Care 2020; 43:2396-2402. [PMID: 32737138 PMCID: PMC7510041 DOI: 10.2337/dc19-2273] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 06/10/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We examined changes in glucose-lowering medication spending and quantified the magnitude of factors that are contributing to these changes. RESEARCH DESIGN AND METHODS Using the Medical Expenditure Panel Survey, we estimated the change in spending on glucose-lowering medications during 2005-2007 and 2015-2017 among adults aged ≥18 years with diabetes. We decomposed the increase in total spending by medication groups: for insulin, by human and analog; and for noninsulin, by metformin, older, newer, and combination medications. For each group, we quantified the contributions by the number of users and cost-per-user. Costs were in 2017 U.S. dollars. RESULTS National spending on glucose-lowering medications increased by $40.6 billion (240%), of which insulin and noninsulin medications contributed $28.6 billion (169%) and $12.0 billion (71%), respectively. For insulin, the increase was mainly associated with higher expenditures from analogs (156%). For noninsulin, the increase was a net effect of higher cost for newer medications (+88%) and decreased cost for older medications (-34%). Most of the increase in insulin spending came from the increase in cost-per-user. However, the increase in the number of users contributed more than cost-per-user in the rise of most noninsulin groups. CONCLUSIONS The increase in national spending on glucose-lowering medications during the past decade was mostly associated with the increased costs for insulin, analogs in particular, and newer noninsulin medicines, and cost-per-user had a larger effect than the number of users. Understanding the factors contributing to the increase helps identify ways to curb the growth in costs.
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Affiliation(s)
- Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sundar S Shrestha
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hui Shao
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Abstract
IMPORTANCE Policy makers have proposed levying penalties for drug price increases that are higher than the rate of inflation for drugs covered in the US Medicare program, but research is lacking regarding the ways in which manufacturers might respond to those penalties. An understanding of manufacturers' responses to existing inflation penalties could inform such policy discussions. OBJECTIVE To estimate the association of existing inflation penalties in the US 340B Drug Pricing Program with manufacturer pricing behavior in the Medicare Part D program and associated changes in Medicare pharmacy expenditures. DESIGN, SETTING, AND PARTICIPANTS This study included a pooled cross-sectional time-series analysis of price changes for Medicare Part D drugs used annually by more than 5000 beneficiaries between January 1, 2013, and December 31, 2017. The percentage of Medicare Part D sales subject to inflation penalties in the 340B program was used to perform a regression analysis to estimate the association of inflation penalties with annual drug price changes. The 340B program requires manufacturers to sell their drugs at a lower price to safety-net health care organizations; this lower price includes a base discount and an additional discount equal to the amount of any price increase that is higher than the rate of inflation. Sales to these 340B-eligible health care organizations represent the market share of a drug subject to inflation penalties. Health care organization-level claims data were obtained from the Medicare Provider Utilization and Payment Data-Part D Prescriber database, and organizations were matched to the Office of Pharmacy Affairs Information System of the Health Resources and Services Administration to identify those organizations that were eligible for the 340B program. Price change and drug use data were obtained from the Medicare Part D Drug Spending Dashboard. Name-brand drugs were included in the analysis if they did not have generic competition and were used by more than 5000 individuals with Medicare Part D in 1 calendar year. Data analysis was conducted from January 1 to February 28, 2020. MAIN OUTCOMES AND MEASURE Annual price change was the primary outcome measure; spending changes associated with lower price increases were also estimated. Sales percentage subject to inflation penalties was the primary independent variable, and formulary classification was a control variable. RESULTS Of 2148 brand-name drugs included in the database, 606 drugs were used by more than 5000 beneficiaries annually, with a mean sales percentage subject to inflation penalties of 12.1%. A higher sales percentage subject to inflation penalties was associated with lower annual price increases (between-effects coefficient, -0.114; 95% CI, -0.205 to -0.023; P = .01; fixed-effects coefficient, -0.380; 95% CI, -0.466 to -0.294; P < .001). Lower price increases owing to inflation penalties were estimated to be associated with a reduction in Medicare Part D pharmacy expenditures of $7.1 billion between 2013 and 2017. CONCLUSIONS AND RELEVANCE In this cross-sectional study, increases in the percentage of drug sales subject to inflation penalties were associated with lower annual price increases. Broader application of inflation penalties may help to reduce drug price increases and decrease overall drug spending.
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Dada DA, Aku E, David KB. COVID-19 pandemic and antiretrovirals (ARV) availability in Nigeria: recommendations to prevent shortages. Pan Afr Med J 2020; 35:149. [PMID: 33193964 PMCID: PMC7608769 DOI: 10.11604/pamj.supp.2020.35.149.25639] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 12/02/2022] Open
Abstract
HIV/AIDS is an infectious disease that has claimed the lives of millions of people worldwide. Currently, there is no vaccine that has been developed in a bid to fight this deadly infection, however, antiretrovirals (ARVs), which are drugs used in the treatment of HIV infection are routinely prescribed to infected persons. They act via several mechanisms of action to reduce the severity of infection and rate of infectivity of the virus by decreasing the viral load while increasing CD4 counts. COVID-19 pandemic has resulted in unprecedented events affecting almost all areas of humans' life including availability of medicines and other consumables. This paper analyses the availability of ARVs during COVID-19 era and offered recommendations to be adopted in order to prevent shortages.
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Affiliation(s)
- David Adelekan Dada
- Faculty of Pharmaceutical Sciences, Kaduna State University, Kaduna, Nigeria
| | - Emmanuel Aku
- Department of Microbiology, Kaduna State University, Kaduna, Nigeria
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Mattingly TJ, Love BL. Changes in Cost-Effectiveness for Chronic Hepatitis C Virus Pharmacotherapy: The Case for Continuous Cost-Effectiveness Analyses. J Manag Care Spec Pharm 2020; 26:879-886. [PMID: 32584675 PMCID: PMC10391261 DOI: 10.18553/jmcp.2020.26.7.879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cost-effectiveness evaluations for hepatitis C virus (HCV) treatments have been published frequently, but new products with significant cost and effectiveness differences make these analyses obsolete. How valuable are economic models for a fixed time period in a dynamic market? OBJECTIVE To estimate the cost-effectiveness of the best available HCV treatment at different points in time, using the same comparator to demonstrate how rapid innovation in a disease area influences economic outcomes. METHODS A Markov model was used to calculate the cost-effectiveness of treatment in 2010, 2012, 2014, 2016, and 2018 compared with a standard comparator (no treatment) from the payer perspective. Expected drug costs and treatment effectiveness estimates for sustained virologic response (SVR) were calculated using recommended regimens for each of the 6 HCV genotypes at each time point and distribution of genotypes in the United States. Patients entered the model with different stages of fibrosis. Utility estimates for each health state were used to calculate quality-adjusted life-years (QALYs) earned at each cycle. Incremental cost-effectiveness ratios were reported for each year to compare the "treatment versus no treatment" decision at that time. RESULTS No HCV treatment resulted in a gain of 11.54 QALYs over a 20-year time horizon at a cost of $42,938. Costs for treated groups were $69,075, $123,267, $125,431, $86,782, and $56,470 for the 2010, 2012, 2014, 2016, and 2018 scenarios, respectively. QALYs gained for treated groups were 12.90, 12.97, 13.34, 13.39, and 13.46 for the 2010, 2012, 2014, 2016, and 2018 scenarios, respectively. The incremental cost-effectiveness ratios in each year compared with no treatment were $19,218 per QALY, $56,104 per QALY, $45,829 per QALY, $23,699 per QALY, and $7,048 per QALY. CONCLUSIONS Treatment effectiveness for HCV has increased steadily, while treatment costs increased substantially from 2010-2014 before decreasing to its lowest point in 2018. Thus, the dynamic nature of innovation creates the need for iterative cost-effectiveness analyses. DISCLOSURES No outside funding supported this study. Mattingly reports unrelated consulting from the National Health Council, Bristol Myers Squibb, G&W Laboratories, Allergy and Asthma Foundation of American, and the Massachusetts Health Policy Commission. Love reports an unrelated research grant from the American Cancer Society.
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Affiliation(s)
- T. Joseph Mattingly
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore
| | - Bryan L. Love
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia
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Affiliation(s)
| | - Melissa J Barber
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Andrew M Hill
- Department of Translational Medicine, University of Liverpool, Liverpool, UK
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Noels E, Hollestein L, Luijkx K, Louwman M, de Uyl-de Groot C, van den Bos R, van der Veldt A, Grünhagen D, Wakkee M. Increasing Costs of Skin Cancer due to Increasing Incidence and Introduction of Pharmaceuticals, 2007-2017. Acta Derm Venereol 2020; 100:adv00147. [PMID: 32189004 PMCID: PMC9137355 DOI: 10.2340/00015555-3463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Skin cancer is the most common type of cancer and its incidence is increasing. The objective of this study was to describe the trends in reimbursed drug and hospital costs of benign and (pre)malignant skin tumours, and to present future projections. Therefore, nationwide hospital and drug reimbursement data (for the period 2007-17) were used. In 2017, malignant skin tumours were the 4th most costly cancer in the Netherlands (after breast, colorectal, and lung cancer). The total costs for skin tumours increased from €278 million for 384,390 patients (in 2007) to €465 million for 578,355 patients (in 2017). Drug costs increased from €0.7 million to €121 million (over the period 2007-17), resulting in a 26% share of overall costs in 2017. Future costs are projected to reach €1.35 billion in 2030. In conclusion, the increasing costs of skin cancer are strongly affected by the increasing incidence and introduction of expensive drugs, and future projections are for an alarming increase.
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Affiliation(s)
- Eline Noels
- Department of Dermatology , Erasmus Medical Center Cancer Institute, Dr. Molewaterplein 40, NL-3015 GD Rotterdam, The Netherlands. E-mail:
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26
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Nguyen HP, Go JA, Barbieri JS, Stough D, Stoff BK, Forman HP, Bolognia JL, Albrecht J. Dissecting drug pricing: Supply chain, market, and nonmarket trends impacting clinical dermatology. J Am Acad Dermatol 2020; 83:691-699. [PMID: 32330637 DOI: 10.1016/j.jaad.2020.04.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/01/2020] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Harrison P Nguyen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
| | | | - John S Barbieri
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dow Stough
- Department of Dermatology, University of Arkansas Medical Science Campus, Little Rock, Arkansas
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Howard P Forman
- Department of Public Health (Health Policy), Economics, and Management, Yale University, New Haven, Connecticut
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Joerg Albrecht
- Division of Dermatology, Department of Medicine, J.H. Stroger, Jr, Hospital of Cook County, Chicago, Illinois; Department of Dermatology, Rush Medical College, Chicago, Illinois
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Athanasakis K, Prodromiadou E, Papazafiropoulou A, Koutsovasilis A, Driva S, Ziori M, Georgopoulos E, Gougourelas D, Sotiropoulos A, Bousboulas S, Melidonis A, Liatis S. Twenty-year trends in the prescription costs of Type 2 diabetes: Real world data and empirical analysis in Greece. Diabetes Res Clin Pract 2020; 162:108095. [PMID: 32112790 DOI: 10.1016/j.diabres.2020.108095] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022]
Abstract
AIMS To estimate and compare the prescription costs for the management of patients with diabetes over a period of 20 years in Greece, based on real world data. METHODS The records of outpatients with T2D, monitored at three diabetes centres, were examined in four cross-sections (1998, 2006, 2012, 2018). Prescribed medicines per patient, along with a set of clinical indicators were recorded. Annual costs of pharmaceutical treatment per patient were calculated by using each year's nominal retail prices, as well as by adjusting for 2018 price levels, in order to account for price differences over time. RESULTS 4066 patients were included in the analysis. Prescription patterns indicate a quick uptake of the new classes of glucose-lowering drugs and a reduction in the proportional use of sulfonylurea and glitazone. Adjusting for 2018 prices, the average total annual prescription cost per patient was 381.54 Euros (s.d. 297.44) in 1998 and 1147.21 Euros (s.d. 814.39) in 2018. Glucose-lowering drug costs per patient increase from 1998 onwards, whereas the costs of antihypertensive, antiplatelet and lipid-lowering treatment declined gradually, especially after 2006. CONCLUSIONS Per patient prescription costs for glucose-lowering drugs present a steep increase, in Greece over the last 20 years. Real-world evidence studies that compare this increase with the changes in patient outcomes are essential in order to examine whether a costs-vs-outcomes balance is optimal.
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Affiliation(s)
- Kostas Athanasakis
- Department of Public Health Policy, School of Public Health, University of West Attica, Greece.
| | - Elisavet Prodromiadou
- First Department of Propaedeutic Medicine, Diabetes Center, Laiko Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Athanasia Papazafiropoulou
- First Department of Internal Medicine and Diabetes Center, General Hospital of Piraeus "Tzaneio", Greece
| | | | - Stamatina Driva
- First Department of Propaedeutic Medicine, Diabetes Center, Laiko Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Maria Ziori
- First Department of Propaedeutic Medicine, Diabetes Center, Laiko Hospital, Medical School, National & Kapodistrian University of Athens, Greece
| | - Elias Georgopoulos
- First Department of Internal Medicine and Diabetes Center, General Hospital of Piraeus "Tzaneio", Greece
| | | | | | | | - Andreas Melidonis
- First Department of Internal Medicine and Diabetes Center, General Hospital of Piraeus "Tzaneio", Greece
| | - Stauros Liatis
- First Department of Propaedeutic Medicine, Diabetes Center, Laiko Hospital, Medical School, National & Kapodistrian University of Athens, Greece
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Affiliation(s)
- Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy
- Center for Pharmaceutical Policy and Prescribing (CP3), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tina Batra Hershey
- Center for Pharmaceutical Policy and Prescribing (CP3), University of Pittsburgh, Pittsburgh, Pennsylvania
- Graduate School of Public Health, Department of Health Policy and Management, University of Pittsburgh
| | - Julie M Donohue
- Center for Pharmaceutical Policy and Prescribing (CP3), University of Pittsburgh, Pittsburgh, Pennsylvania
- Graduate School of Public Health, Department of Health Policy and Management, University of Pittsburgh
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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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Bang C, Mortensen MB, Lauridsen KG, Bruun JM. Trends in antidiabetic drug utilization and expenditure in Denmark: A 22-year nationwide study. Diabetes Obes Metab 2020; 22:167-172. [PMID: 31486269 DOI: 10.1111/dom.13877] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 01/09/2023]
Abstract
AIMS To examine the nationwide trends in antidiabetic drug utilization and expenditure in Denmark over the past 22 years. METHODS Data on antidiabetic use and expenditure from 1996 to 2017 were retrieved from the Register of Medicinal Product Statistics. Antidiabetic drug use is reported as defined daily dose (DDD) in total counts and per 1000 inhabitants/d. Expenditure is reported as volume sold in total counts per 1000 inhabitants and as annual mean expenditure. RESULTS Throughout the study period, the total use of antidiabetic drugs increased from 16.4 to 55.8 DDDs per 1000 inhabitants/d, while total expenditure increased from €59 to €286 m. The introduction of glucagon-like peptide-1 receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 inhibitors and sodium-glucose co-transporter-2 inhibitors has, since 2005, led to considerable variation in the proportional use of the different drug classes. Use of insulin and insulin analogues accounted for the majority of the cost of antidiabetic drugs, peaking at 75% in 2008; however, its proportional impact on overall antidiabetic drug expenditure decreased to ~44% in 2017. In contrast, a steep increase in GLP-1RA expenditure was observed from 2010 to 2017, reaching an annual cost of €85 m (~29% of all antidiabetic expenditure). CONCLUSION Antidiabetic drug utilization and cost in Denmark has increased considerably over the last 22 years, in accordance with the increased incidence of type 2 diabetes and changes in treatment guidelines. The release of several novel antidiabetic drugs seems to be responsible for the increase in antidiabetic drug expenditure.
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Affiliation(s)
- Camilla Bang
- Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
- Clinical Research Unit, Randers Regional Hospital, Randers, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Martin B Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper G Lauridsen
- Research Centre for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
- Clinical Research Unit, Randers Regional Hospital, Randers, Denmark
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
| | - Jens M Bruun
- Department of Internal Medicine, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Centre Aarhus, Aarhus, Denmark
- Department of Nutrition, Exercise and Sports, Copenhagen University Hospital, Copenhagen, Denmark
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Affiliation(s)
- Steven G Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Suerie Moon
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
- Harvard T H Chan School of Public Health, Boston, MA, USA
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Miller S. Generic Drugs: A Treatment for High-Cost Health Care. Mo Med 2020; 117:12-13. [PMID: 32158033 PMCID: PMC7023936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Steve Miller
- Steve Miller, MD, serves as Cigna's Chief Clinical Officer, and leads the company's clinical policy, quality, and performance efforts. He formerly served as Senior Vice President and Chief Medical Officer for Express Scripts and received his medical degree from the University of Missouri-Kansas City, Kansas City, Missouri
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Atlas S. How to Reduce Prescription Drug Prices: First, Do No Harm. Mo Med 2020; 117:14-15. [PMID: 32158034 PMCID: PMC7023937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Scott Atlas
- Scott W. Atlas, MD, is a senior fellow at Stanford's Hoover Institution and author of "Restoring Quality Health Care: A six Point Plan for Comprehensive Reform at Lower Cost."
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Abstract
In this cohort study, pricing data from January 2007 to June 2018 from SSR Health were used to determine how list prices, net prices, and discounts for the originator biologics changed with biosimilar competition.
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Affiliation(s)
- Alvaro San-Juan-Rodriguez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Walid F. Gellad
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Chester B. Good
- Center for High-Value Health Care, Insurance Services Division, UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
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Affiliation(s)
- Michael Fralick
- From Mount Sinai Hospital and the Division of General Internal Medicine, Department of Medicine, University of Toronto - both in Toronto (M.F.); and the Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (A.K.)
| | - Aaron S Kesselheim
- From Mount Sinai Hospital and the Division of General Internal Medicine, Department of Medicine, University of Toronto - both in Toronto (M.F.); and the Program on Regulation, Therapeutics, and Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (A.K.)
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Nejim B, Alshwaily W, Faateh M, Locham S, Dakour-Aridi H, Malas M. Trend and Economic Burden of Intravenous Narcotic Analgesic Utilization in Major Vascular Interventions in the United States. Ann Vasc Surg 2019; 66:289-300.e2. [PMID: 31678548 DOI: 10.1016/j.avsg.2019.10.076] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of IV narcotic analgesics (IVNA) within the context of vascular procedures is not fully described. We sought to evaluate the burden of IVNA including narcotic analgesia-related adverse drug events (NARADE), associated mortality and hospitalization cost in open and endovascular vascular procedures, and to compare it with nonnarcotic analgesia (IVNNA). METHODS Retrospective cross-sectional study in hospitals participating in Premier database (2009-2015). Logistic regression analysis was implemented to report the risks of NARADE and in-hospital mortality. Negative binomial regression was used to assess length of stay and generalized linear modeling was used to estimate the hospitalization cost. RESULTS A total of 171,473 patients were identified. NARADE occurred in 6.2% of the cohort. NARADE group was similar in gender and race but was slightly older (median age 71 vs. 70; P < 0.001). After risk-adjustment, NARADE risk was higher in patients who received IVNA-alone in carotid and lower extremity revascularization (LER) [OR (odds ratio) (95% confidence interval [CI]): 1.17 (1.02-1.34) and 1.31 (1.14-1.50)] or combined with IVNNA [OR (95% CI): 1.34 (1.13-1.59) and 1.81 (1.54-2.13)], respectively. Patients receiving aortic repair benefited from the use of IVNA + IVNNA [OR (95% CI): 0.82 (0.69-0.98)]. Occurrence of NARADE doubled the LOS, amplified mortality risk and increased cost in all domains. NARADE increased the odds of mortality by 24.3, 6.5 (4.9-8.68) and 16.6 times and added $5,368, $12,737 and $11,349 to the cost of carotid, aortic and LER interventions, respectively. In contrast, IVNNA was not associated with NARADE risk, increased LOS or cost and showed a survival benefit in patients undergoing open aortic repair [aOR (95% CI): 0.52 (0.36-0.75)]. CONCLUSIONS AND RELEVANCE The use of opioid-based narcotics had increased the risk of NARADE, resources utilization and NARADE-related mortality. Yet the use of nonopioid-based analgesic was safe, did not increase the cost and reduced mortality in open AA repair. This entices shifting the paradigm toward exploring nonopioid-based analgesia options in order to replace or minimize opioid requirements.
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Affiliation(s)
- Besma Nejim
- Department of Vascular Surgery, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA
| | | | - Muhammad Faateh
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | - Mahmoud Malas
- Department of Surgery, UC San Diego School of Medicine, La Jolla, CA.
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38
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Affiliation(s)
- Chintan V Dave
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA.
| | - Gregory Brill
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, USA
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Abstract
Aim: Drug innovation is strongly driven by economic incentives. How these incentives work in determining or changing the level of activity of innovators and the direction of their innovation remains understudied. We seek to address these issues in reviewing recent literature on drug innovation, which offers one major unifying theme of pharmacoeconomic scholarship presented at the 2019 AEA-ASSA annual convention. Methods: Drawn from three AEA-ASSA convention panel sessions, papers were reviewed for newly charted research terrains and new research trajectories, and their theoretical and practical implications on efficiency, effectiveness, and value in the production and utilization of pharmaceutical products. Results: While high and continuously rising drug prices are typically claimed as the price of scientific innovation, the reviewed literature finds that this link only partially accounts for the problem. High risk aversion owing to information asymmetries and vastly intractable uncertainties is prevalent among innovating firms. Predatory business models abound. Reverse predatory strategies also exist to maintain product exclusivity without much added clinical benefits, and to constrain generic competition. CEO compensation practices contribute to rising drug prices. Finally, the US government's hands-off policy on drug list prices leave the forces of supply and demand to allocate them and reward innovation (at times perversely), even as the government extensively regulates or over-regulates practically every other aspect of innovation. Conclusions: Price-elasticity of demand is critical in drug innovation. The drug value chain is price-sensitive to the balance of incentives and disincentives to innovation. American health policy should consider charting a middle course that introduces some form of regulatory price control, while stimulating and sustaining the benefits of market competition. That should incentivize stakeholders to take into account both resources and value for money in making decisions based on best-quality, clinical-economic evidence.
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Abstract
This study characterizes price increases exceeding inflation between 2012 and 2017 for protected-class drugs (antineoplastics, antiretrovirals, antidepressants, antipsychotics, anticonvulsants, and immunosuppressants for transplant patients) that would lead to their exclusion from Medicare Part D coverage based on excessive cost under a 2018 CMS rule intended to facilitate more effective price negotiations.
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Affiliation(s)
| | - Stacie B. Dusetzina
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Josh Feng
- National Bureau of Economic Research, Boston, Massachusetts
| | - Luca Maini
- University of North Carolina at Chapel Hill
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Sarpatwari A, DiBello J, Zakarian M, Najafzadeh M, Kesselheim AS. Competition and price among brand-name drugs in the same class: A systematic review of the evidence. PLoS Med 2019; 16:e1002872. [PMID: 31361747 PMCID: PMC6667132 DOI: 10.1371/journal.pmed.1002872] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/27/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Some experts have proposed combating rising drug prices by promoting brand-brand competition, a situation that is supposed to arise when multiple US Food and Drug Administration (FDA)-approved brand-name products in the same class are indicated for the same condition. However, numerous reports exist of price increases following the introduction of brand-name competition, suggesting that it may not be effective. We performed a systematic literature review of the peer-reviewed health policy and economics literature to better understand the interplay between new drug entry and intraclass drug prices. METHODS AND FINDINGS We searched PubMed and EconLit for original studies on brand-brand competition in the US market published in English between January 1990 and April 2019. We performed a qualitative synthesis of each study's data, recording its primary objective, methodology, and results. We found 10 empirical investigations, with 1 study each on antihypertensives, anti-infectives, central nervous system stimulants for attention deficit/hyperactivity disorder, disease-modifying therapies for multiple sclerosis, histamine-2 (H2) blockers, and tumor necrosis factor (TNF) inhibitors; 2 studies on cancer medications; and 2 studies on all marketed or new drugs. None of the studies reported that brand-brand competition lowers list prices of existing drugs within a class. The findings of 2 studies suggest that such competition may help restrain how new drug prices are set. Other studies found evidence that brand-brand competition was mediated by the relative quality of competing drugs and the extent to which they are marketed, with safer or more effective new drugs and greater marketing associated with higher intraclass list prices. Our investigation was limited by the studies' use of list rather than net prices and the age of some of the data. CONCLUSIONS Our findings suggest that policies to promote brand-brand competition in the US pharmaceutical market, such as accelerating approval of non-first-in-class drugs, will likely not result in lower drug list prices absent additional structural reforms.
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Affiliation(s)
- Ameet Sarpatwari
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Jonathan DiBello
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Marie Zakarian
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mehdi Najafzadeh
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Aaron S. Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
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Kleinrock M, Westrich K, Buelt L, Aitken M, Dubois RW. Reconciling the Seemingly Irreconcilable: How Much Are We Spending on Drugs? Value Health 2019; 22:792-798. [PMID: 31277826 DOI: 10.1016/j.jval.2018.11.009] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Estimates of drug spending are often central to the public policy debate on how to manage healthcare spending in the United States. Nevertheless, common estimates of prescription drug spending vary substantially by source, which can inhibit productive policy dialogue. OBJECTIVES To review publicly reported estimates of drug spending and uncover the underlying methodological inputs that drive the substantial variation in estimates of prescription drug spending. METHODS We systematically evaluated 5 estimates of drug spending to identify differences in the underlying methodological inputs and approaches. To uniformly assess and compare estimates, we developed a model to identify the inputs of 3 primary components associated with each estimate: numerator (How is drug cost measured?), denominator (How is healthcare cost measured?), and population (What group of individuals is included in the measurement?). We then applied standardized methodological inputs to each estimate to assess whether variation among estimates could be reconciled. We then conducted a sensitivity analysis to address important limitations. RESULTS We found that the 18.8 percentage point range in the publicly reported estimates is predominately attributed to methodological differences. Reconciling estimates using a standardized methodological approach reduces this range to 4.0 percentage points. CONCLUSIONS Because variation in estimates of drug spending is primarily driven by methodological differences, stakeholders should seek to establish a mutually agreed upon methodological approach that is appropriate for the policy question at hand to provide a sound basis for health spending policy discussions.
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Affiliation(s)
| | | | - Lisabeth Buelt
- The National Pharmaceutical Council, Washington, DC, USA
| | - Murray Aitken
- IQVIA Institute for Human Data Science, Plymouth Meeting, PA, USA
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Beran D, Laing RO, Kaplan W, Knox R, Sharma A, Wirtz VJ, Frye J, Ewen M. A perspective on global access to insulin: a descriptive study of the market, trade flows and prices. Diabet Med 2019; 36:726-733. [PMID: 30888075 PMCID: PMC6593686 DOI: 10.1111/dme.13947] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 01/23/2023]
Abstract
AIM To describe the global insulin market. METHODS Market intelligence data, United Nations Commodity Trade Statistics for insulin trade, the International Medical Products Price Guide for prices of human insulin and additional web searches were used as data sources. These sources were combined to gain further insight into possible links among market, trade flows and prices. Descriptive statistics and Spearman's rank order correlation were used for the analysis. RESULTS A total of 34 insulin manufacturers were identified. Most countries and territories are reliant on a limited number of supplying countries. The overall median (interquartile range) government procurement price for a 10-ml, 100-IU/ml vial during the period 1996-2013 equivalent was US$4.3 (US$ 3.8-4.8), with median prices in Africa (US$ 4.7) and low- (US$ 6.9) and low- to middle- (US$ 4.7) income countries being higher over this period. The relationships between price and quantity of insulin (Spearman's r=0.046; P>0.1) and number of import links (Spearman's r=0.032; P>0.1) were weak. The links between price and percentage of total insulin from a country where a 'big three' manufacturer produces insulin (Spearman's r=0.294; P<0.05) and total insulin from the main import link (Spearman's r=-0.392; P<0.05) were stronger. CONCLUSIONS This research shows the high variability of insulin prices and the reliance on a few sources, both companies and countries, for global supply. In addressing access to insulin, countries need to use existing price data to negotiate prices, and mechanisms need to be developed to foster competition and security of supply of insulin, given the limited number of truly global producers.
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Affiliation(s)
- D. Beran
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
| | - R. O. Laing
- Boston University School of Public HealthBostonMAUSA
- Faculty of Community Health SciencesSchool of Public HealthUniversity of the Western CapeCape TownSouth Africa
| | - W. Kaplan
- Boston University School of Public HealthBostonMAUSA
| | - R. Knox
- Boston University School of Public HealthBostonMAUSA
| | - A. Sharma
- Boston University School of Public HealthBostonMAUSA
- Precision Health EconomicsBostonMAUSA
| | - V. J. Wirtz
- Boston University School of Public HealthBostonMAUSA
| | - J. Frye
- Management Sciences for HealthMedfordMAUSA
| | - M. Ewen
- Health Action InternationalAmsterdamThe Netherlands
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Abstract
OBJECTIVES To investigate the trend in the launch price of new drugs for five common health conditions. DESIGN Cross-sectional study using data on new drugs launched in the UK between 1981 and 2015 for hypertension, asthma, rheumatoid arthritis, schizophrenia and colorectal cancer. DATA AND SOURCES All drugs marketed in the UK between 1981 and 2015 (inclusive), and licensed specifically for the treatment of one of the five chosen conditions were included in the study. Newly launched medicines and their launch prices were identified by hand-searching all editions of the British National Formulary in addition to searching the websites of relevant regulatory agencies (European Medicines Agency and Medicines and Healthcare products Regulatory Agency). The launch price in UK pounds for a 28-day supply of each medicine at a typical or usual maintenance dose was adjusted for the effects of general inflation using the gross domestic product deflator series. RESULTS 104 drugs were included in our study with a mean inflation-adjusted 28-day launch price of £288 (SD £678). The launch price of new drugs varied significantly across the five conditions, with drugs for hypertension having the lowest mean price (£27) and drugs for colorectal cancer having the highest mean price (£1590) (p<0.001). There were large increases in launch prices across the study period, but the magnitude and pattern was markedly different between therapeutic areas. Biological drugs represented 13.5% of all included drugs and had a significantly higher launch price than non- biological drugs (£1233 vs £141, p<0.001). 22.1% of included drugs were first-of-kind and had a significantly higher launch price than follow-on drugs (£768 vs £151) (p<0.0001). CONCLUSION Drugs prices continue to increase across different therapeutic areas. This has some association with novelty, but, it is not clear if this increase in price is associated with medical benefits.
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Affiliation(s)
- Derek J Ward
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucy Doos
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Andrew Stevens
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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45
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Abstract
IMPORTANCE High and continually increasing pharmaceutical drug spending is a major health and health policy concern in the United States. OBJECTIVE To demonstrate trends in prices among popular brand-name prescription drugs. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation of drug prices focuses on 49 top-selling brand-name medications in the United States. Pharmacy claims data from January 1, 2012, through December 31, 2017, were obtained from Blue Cross Blue Shield Axis, a database that includes data from more than 35 million individuals with private pharmaceutical insurance. Drugs that exceeded $500 million in US sales or $1 billion in worldwide sales were examined. MAIN OUTCOMES AND MEASURES The median sum of out-of-pocket and insurance costs paid by patients or insurers for common prescriptions, presented annually and monthly, was the primary outcome. RESULTS In total, 132 brand-name prescription drugs were identified in 2017 that met the inclusion criteria. Of this total, the study focused on 49 top-selling drugs that exceeded 100 000 pharmacy claims. Substantial cost increases among these drugs was near universal, with a 76% median cost increase from January 2012 through December 2017, and almost all drugs (48 [98%]) displaying regular annual or biannual price increases. Of the 36 drugs that have been available since 2012, 28 (78%) have seen an increase in insurer and out-of-pocket costs by more than 50%, and 16 (44%) have more than doubled in price. Insulins (ie, Novolog, Humalog, and Lantus) and tumor necrosis factor inhibitors (ie, Humira and Enbrel) demonstrated highly correlated price increases, coinciding with some of the largest growth in drug costs. Relative price changes did not differ between drugs that entered the market in the past 3 to 6 years and those that have been on the market longer (number of drugs, 13 vs 36; median, 29% increase from January 2015 through December 2017; P = .81) nor between drugs with or without a Food and Drug Administration-approved therapeutic equivalent (number of drugs, 17 vs 32; median, 79% vs 73%; P = .21). Changes in prices paid were highly correlated with third-party estimates of changes in drug net prices (ρ = 0.55; P = 3.8 × 10-5), suggesting that the current rebate system, which incentivizes high list prices and greater reliance on rebates, increases overall costs. CONCLUSIONS AND RELEVANCE The growth of drug spending in the United States associated with government-protected market exclusivity is likely to continue; greater price transparency is warranted.
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Affiliation(s)
| | - Yunyue Zhang
- Translational Institute, Scripps Research, La Jolla, California
| | - Eric J. Topol
- Translational Institute, Scripps Research, La Jolla, California
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46
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Bach PB. Insights into the increasing costs of cancer drugs. Clin Adv Hematol Oncol 2019; 17:287-298. [PMID: 31188807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Peter B Bach
- Memorial Sloan Kettering Cancer Center, New York, New York
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47
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Abstract
This study uses Medicaid drug utilization data to describe reimbursement and market share of long-acting insulins before and after approval of new insulin products and to estimate savings associated with a “biosimilar” for insulin glargine approved in 2015.
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Affiliation(s)
- Inmaculada Hernandez
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Chester B. Good
- Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - William H. Shrank
- Insurance Services Division, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Now with Humana, Louisville, Kentucky
| | - Walid F. Gellad
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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48
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Gudiksen KL, King JS. The Burden of Federalism: Challenges to State Attempts at Controlling Prescription Drug Costs. J Leg Med 2019; 39:95-120. [PMID: 31503534 DOI: 10.1080/01947648.2019.1645541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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49
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Helmuth ME, Liu Q, Turenne MN, Park JM, Oguntimein M, Dutcher SK, Balkrishnan R, Sharma P, Zee J, Leichtman AB, Smith AR. Secular Trends in the Cost of Immunosuppressants after Solid Organ Transplantation in the United States. Clin J Am Soc Nephrol 2019; 14:421-430. [PMID: 30819667 PMCID: PMC6419280 DOI: 10.2215/cjn.10590918] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/04/2018] [Accepted: 01/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Immunosuppressive medications are critical for maintenance of graft function in transplant recipients but can represent a substantial financial burden to patients and their insurance carriers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS To determine whether availability of generic immunosuppressive medications starting in 2009 may have alleviated some of that burden, we used Medicare Part D prescription drug events between 2008 and 2013 to estimate the average annualized per-patient payments made by patients and Medicare in a large national sample of kidney, liver, and heart transplant recipients. Repeated measures linear regression was used to determine changes in payments over the study period. RESULTS Medicare Part D payments for two commonly used immunosuppressive medications, tacrolimus and mycophenolic acid (including mycophenolate mofetil and mycophenolate sodium), decreased overall by 48%-67% across organs and drugs from 2008 to 2013, reflecting decreasing payments for brand and generic tacrolimus (21%-54%), and generic mycophenolate (72%-74%). Low-income subsidy payments, which are additional payments made under Medicare Part D, also decreased during the study period. Out-of-pocket payments by patients who did not receive the low-income subsidy decreased by more than those who did receive the low-income subsidy (63%-79% versus 24%-44%). CONCLUSIONS The decline in payments by Medicare Part D and by transplant recipients for tacrolimus and mycophenolate between 2008 and 2013 suggests that the introduction of generic immunosuppressants during this period has resulted in substantial cost savings to Medicare and to patients, largely reflecting the transition from brand to generic products.
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Affiliation(s)
| | - Qian Liu
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Marc N. Turenne
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Jeong M. Park
- College of Pharmacy, University of Michigan, Ann Arbor, Michigan
| | - Murewa Oguntimein
- Center for Drug Evaluation and Research, US Food and Drug Administration, Washington, DC; and
| | - Sarah K. Dutcher
- Center for Drug Evaluation and Research, US Food and Drug Administration, Washington, DC; and
| | - Rajesh Balkrishnan
- Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Pratima Sharma
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
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50
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Parekh N, McClellan M, Shrank WH. Payment Reform, Medication Use, and Costs: Can We Afford to Leave Out Drugs? J Gen Intern Med 2019; 34:473-476. [PMID: 30604128 PMCID: PMC6420553 DOI: 10.1007/s11606-018-4794-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/15/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
Medications are one of the fastest growing sources of costs in the health system and the cornerstone of disease management. Despite extensive attention around drug pricing, medications have largely been excluded from CMS-derived, value-based payment models. In this perspective, we synthesize evidence about the impact of three prominent models-primary care-based redesign, ACOs, and bundled payment programs-on medication use, adherence, and costs. We also examine the literature describing similar models implemented by private payors and their relationship with medication use and costs. The exclusion of drug costs from payment reform model design has led to missed opportunities for payors and providers to prioritize effective medication management strategies and has limited our learning about the effects on cost and quality. New CMS-based models are starting to allow greater flexibility in pharmacy benefit design and reward improved medication therapy management. Additionally, health plans, pharmacies, and pharmacy benefit managers are beginning to partner on collaborative value-based pharmacy initiatives. Taken together, these efforts encourage a paradigm shift around drug cost management that more deeply integrates pharmacy into payment and delivery reform with the goal of improving quality and reducing the total cost of care.
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Affiliation(s)
- Natasha Parekh
- Division of General Internal Medicine, University of Pittsburgh, Lothrop Street, Pittsburgh, PA, USA.
- Center for High-Value Health Care and Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA.
| | - Mark McClellan
- Duke Margolis Health Center for Policy, Washington, DC, USA
| | - William H Shrank
- Center for High-Value Health Care and Center for Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA
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