scholarly journals Utilization of Generic Cardiovascular Drugs in Medicare’s Part D Program

2021 ◽  
Author(s):  
Iris Ma ◽  
Rebecca L. Tisdale ◽  
Daniel Vail ◽  
Paul A. Heidenreich ◽  
Alexander T. Sandhu
Keyword(s):  
Generic Substitution ◽  
Cost Savings ◽  
Medicare Part D ◽  
Cardiovascular Drugs ◽  
Medicare Part ◽  
Brand Name ◽  
Potential Cost ◽  
Part D ◽  
Patient Consent ◽  
Generic Medications

Background: Generic medications cost less than brand-name medications and are similarly effective, but brand-name medications are still prescribed. We evaluated patterns in generic cardiovascular medication fills and estimated the potential cost savings with increased substitution of generic for brand-name medications. Methods: This was a cross-sectional study of cardiovascular therapies using the Medicare Part D database of prescription medications in 2017. We evaluated drug fill patterns for therapies with available brand-name and generic options. We determined the generic substitution ratio and estimated the potential savings with increased generic substitution at the national, state, and clinician level. We compared states with laws related to mandatory pharmacist generic substitution and patient consent for substitution. Results: Of ≈$22.9 billion spent on cardiovascular drugs in Medicare Part D prescription programs in 2017, ≈$11.0 billion was spent on medications with both brand-name and generic options. Although only 2.4% of medication fills were for the brand-name choice, they made up 21.2% of total spending. Accounting for estimated brand-name rebates, generic substitution for these medications would save $641 million, including $135 million in costs shouldered by patients. Furthermore, the minority of clinicians with the lowest generic utilization was responsible for a large proportion of the potential cost savings. Conclusions: There are substantial potential cost savings from substituting brand-name medications with generic medications. These savings would be primarily driven by lower use of brand-name therapies by the minority of clinicians who prescribe them at increased rates.

scholarly journals The role of county-level socioeconomic status on brand-name prescriptions in Medicare part D

Medicine ◽  
2020 ◽  
Vol 99 (9) ◽  
pp. e19271
Author(s):  
Connor Volpi ◽  
Fadi Shehadeh ◽  
Eleftherios Mylonakis
Keyword(s):  
Socioeconomic Status ◽  
Medicare Part D ◽  
Medicare Part ◽  
County Level ◽  
Brand Name ◽  
Part D

Medicare Part D Plans Rarely Cover Brand-Name Drugs When Generics Are Available

2020 ◽  
Vol 39 (8) ◽  
pp. 1326-1333
Author(s):  
Stacie B. Dusetzina ◽  
Juliette Cubanski ◽  
Leonce Nshuti ◽  
Sarah True ◽  
Jack Hoadley ◽  
...  
Keyword(s):  
Medicare Part D ◽  
Medicare Part ◽  
Brand Name ◽  
Part D ◽  
Brand Name Drugs

Biosimilar uptake of filgrastim and impact on spending in Medicare Part D from 2015 to 2019.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 67-67
Author(s):  
Syed Hussaini ◽  
Arjun Gupta ◽  
Kelly E. Anderson ◽  
Jeromie M. Ballreich ◽  
Lauren H. Nicholas ◽  
...  
Keyword(s):  
Cost Savings ◽  
Medicare Part D ◽  
The United States ◽  
Medicare Part ◽  
Drug Event ◽  
Cross Sectional ◽  
Part D ◽  
Medicare Part B ◽  
Significant Uptake ◽  
Biosimilar Filgrastim

67 Background: The introduction of a filgrastim biosimilar in 2014 was associated with substantial cost savings in Medicare Part B and Medicaid programs. However, Medicare Part D is unique since it is unable to directly negotiate prices with drug manufacturers. We sought to investigate the uptake of filgrastim biosimilars and impact on spending among Part D beneficiaries. Methods: We evaluated utilization trends for filgrastim (Neupogen), filgrastim-sndz (Zarxio), and tbo-filgrastim (Granix) using the 2015-2019 Medicare Part D Prescription Drug Event data. We conducted a retrospective cross-sectional review of annual spending, number of beneficiaries, number of claims, spending per beneficiary, and spending per dosage unit. We excluded filgrastim-aafi (Nivestym) due to recent approval and adjusted for inflation using 2019 dollars. Results: In 2019, total aggregate Part D spending on filgrastim products was $78 million. From 2015 to 2019, the biosimilar share of total aggregate spending increased from $1.8 million (2%) to $44 million (56%), with combined biosimilar spending (Zarxio and Granix) eclipsing originator Neupogen in 2018 (within 4 years of FDA approval of Zarxio). Total spending on Neupogen reduced 58% from 2015 to 2019. While biosimilar uptake progressively increased every year, total aggregate spending on all filgrastim forms reduced only 7% from 2015 to 2019 ($84 million to $78 million). For all 3 forms, from 2015 to 2019, trends in spending were: average spending per claim ($3193 to $2549, -20%), average spending per beneficiary ($5880 to $6722, +15%), and average spending per dosage unit of filgrastim ($583 vs $571, -2%). Detailed results in Table. Conclusions: We demonstrate that the significant uptake of biosimilar filgrastim products in Medicare Part D from 2015 to 2019 was associated with a small decrease in aggregate spending, essentially unchanged per unit spending, and increased spending per beneficiary on filgrastim products. Our findings contrast with experiences across Medicare Part B and Medicaid, that demonstrated significant cost savings with biosimilar filgrastim uptake. This may be due to inability of Medicare Part D to directly negotiate prices with manufacturers (in contrast to Medicare Part B and Medicaid), supporting ongoing Congressional policy being debated in the United States Senate (H.R. 3).[Table: see text]

IT PAYS TO COMPARE: ASSISTING MEDICARE PART D BENEFICIARIES WITH ENROLLMENT YIELDS OUT-OF-POCKET COST SAVINGS

2011 ◽  
Vol 59 (5) ◽  
pp. 953-955 ◽  
Author(s):  
Kristin L. Geonnotti ◽  
Gina Upchurch ◽  
Mary T. Roth ◽  
Morris Weinberger
Keyword(s):  
Cost Savings ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D

scholarly journals Sa1028 – Cost Savings from Generic Proton Pump Inhibitors in Medicare Part D from 2013-2016

2019 ◽  
Vol 156 (6) ◽  
pp. S-260
Author(s):  
Andrew J. Read ◽  
Jacob E. Kurlander ◽  
Akbar K. Waljee ◽  
Sameer D. Saini
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Cost Savings ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D

scholarly journals Medicare Part D: Patients Bear The Cost Of ‘Me Too’ Brand-Name Drugs

2016 ◽  
Vol 35 (7) ◽  
pp. 1237-1240 ◽  
Author(s):  
Nicole M. Gastala ◽  
Peter Wingrove ◽  
Anne Gaglioti ◽  
Stephen Petterson ◽  
Andrew Bazemore
Keyword(s):  
Medicare Part D ◽  
Medicare Part ◽  
Brand Name ◽  
Part D ◽  
The Cost ◽  
Brand Name Drugs

scholarly journals Projected spending for brand-name drugs in English primary care given US prices: a cross-sectional study

2020 ◽  
Vol 113 (9) ◽  
pp. 350-359
Author(s):  
Michael Liu ◽  
Brian MacKenna ◽  
William B Feldman ◽  
Alex J Walker ◽  
Jerry Avorn ◽  
...  
Keyword(s):  
Primary Care ◽  
Medicare Part D ◽  
Access To Medicines ◽  
Cross Sectional Study ◽  
Medicare Part ◽  
Brand Name ◽  
Cross Sectional ◽  
Part D ◽  
The Us ◽  
Brand Name Drugs

Summary Objectives To estimate additional spending if NHS England paid the same prices as US Medicare Part D for the 50 single-source brand-name drugs with the highest expenditure in English primary care in 2018. Design Retrospective analysis of 2018 drug prescribing and spending in the NHS England prescribing data and the Medicare Part D Drug Spending Dashboard and Data. We examined the 50 costliest drugs in English primary care available as brand-name-only in the US and England. We performed cost projections of NHS England spending with US Medicare Part D prices. We estimated average 2018 US rebates as 1 minus the quotient of net divided by gross Medicare Part D spending. Setting England and US Participants NHS England and US Medicare systems Main outcome measures Total spending, prescriptions and claims in NHS England and Medicare Part D. All spending and cost measures were reported in 2018 British pounds. Results NHS England spent £1.39 billion on drugs in the cohort. All drugs were more expensive under US Medicare Part D than NHS England. The US–England price ratios ranged from 1.3 to 9.9 (mean ratio 4.8). Accounting for prescribing volume, if NHS England had paid US Medicare Part D prices after adjusting for estimated US rebates, it would have spent 4.6 times as much in 2018 on drugs in the cohort (£6.42 billion). Conclusions Spending by NHS England would be substantially higher if it paid US Medicare Part D prices. This could result in decreased access to medicines and other health services.

Biosimilar formulary placement in Medicare Part D prescription drug plans: A case study of infliximab

2020 ◽  
Author(s):  
Mariana P Socal ◽  
Ijeamaka Ezebilo ◽  
Ge Bai ◽  
Gerard F Anderson
Keyword(s):  
Prescription Drug ◽  
Cost Sharing ◽  
Cost Savings ◽  
Medicare Part D ◽  
Medicare Part ◽  
Prior Authorization ◽  
Part D ◽  
Medicare Program ◽  
Prescription Drug Plans ◽  
Step Therapy

Abstract Purpose Biosimilars can generate competition and provide cost savings over reference biologics for the Medicare program and beneficiaries. The extent to which these benefits can be realized in the Medicare Part D program depends on how biosimilars and biologics are placed in the formulary. We conducted a study to examine Medicare formulary placement of the first biologic to have 2 biosimilars on the market—infliximab and its biosimilars infliximab-dyyb and infliximab-abda. Methods All standalone and Medicare Advantage (MA) prescription drug plans (PDPs) offered in Medicare Part D were examined between September 2016 (ie, at the end of the last quarter before the launch of the first infliximab biosimilar) and September 2018, at which time a second biosimilar had been on the market for about 14 months. When PDPs covered both the reference biologic and a biosimilar, we compared the cost-sharing tier and the frequency of prior authorization and step therapy requirements for each drug. Results Nearly all PDPs covered infliximab throughout the study period. By September 2018, 31.7% of MA plans and 14.9% of standalone PDPs were covering a biosimilar on the market. Nearly all plans that covered a biosimilar also covered the reference product. Most plans (98% of standalone PDPs and 89% of MA plans) had placed prior authorization restrictions on both the biologic and the biosimilar. All plans covering both products placed them in the same cost-sharing tier. No plan required step therapy for either product. Conclusion Formulary placement of infliximab biologic and biosimilars in Medicare Part D is not optimized to generate cost savings for the Medicare program and beneficiaries, whose cost sharing is often based on the drug’s list price. The Medicare program should provide incentives for PDPs to expand biosimilar coverage.

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