Five Year Analysis Assessing the Trend in Prescribing and Expenditures of Oral Oncolytics for Medicare Part D: 2013-2017

2021 ◽  
pp. 089719002110002
Author(s):  
Eric P. Borrelli ◽  
Conor G. McGladrigan
Keyword(s):  
Statistical Significance ◽  
Medicare Part D ◽  
Medicare Part ◽  
First Line ◽  
Chi Square ◽  
Part D ◽  
Medication Costs ◽  
The Mean ◽  
The Cost ◽  
Oral Oncolytics

Introduction: Oral oncolytics are becoming a mainstay in oncology, representing first-line therapies for numerous different malignancies. In addition, the cost of oncology drugs has increased dramatically in recent years. Given the increasing number of oral oncolytics available, as well as the increase in medication costs in recent years, it is important to assess the trend in prescriptions and expenditures of these agents. Methods: A descriptive retrospective analysis of the Medicare Part D Provider Utilization and Payment Data Public Use File (PUF) was conducted for the years 2013 through 2017. Outcomes of interest included total aggregate prescriptions per year, total aggregate expenditures per year, mean expenditure per prescription per year, and mean expenditure per standardized 30-day prescription per year. Chi-square tests were conducted to assess statistical significance of differences in proportions of prescriptions as well as expenditures between 2013 and 2017. Results: The number of prescriptions for oral oncolytics dispensed to Medicare Part D beneficiaries increased from 7,017,902 in 2013 to 8,164,883 in 2017. Medicare Part D expenditures for oral oncolytics increased greater than 2.5-fold from $5,631,224,307 in 2013 to $14,422,681,331 in 2017 after adjusting for inflation. The mean expenditure per prescription for oral oncolytics increased from $802 in 2013 to $1,766 in 2017. Conclusions: This study found oral oncolytic utilization has been increasing in recent years with a slight, but statistically significant increase in the proportion of oncolytics for all Medicare prescriptions from 2013 through 2017.

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

The economic cost and sustainability of the precision oncology promise.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 7-7
Author(s):  
Aakash Desai ◽  
Chelsee Jensen ◽  
Caleb Scheckel ◽  
Jacob Orme ◽  
Sri Harsha Tella ◽  
...  
Keyword(s):  
Growth Rates ◽  
Medicare Part D ◽  
Annual Growth ◽  
Medicare Part ◽  
Precision Oncology ◽  
Part D ◽  
Medication Costs ◽  
True Value ◽  
Anti Cancer ◽  
Average Change

7 Background: Despite the promise of precision oncology, the cost-effectiveness of targeted treatments is debated. Until now, the increase in price of oral targeted anti-cancer treatments used in common malignancies has not been evaluated. Here, we report patterns in price changes from 2015-2019 for multiple oral anti-cancer medications for common solid tumor malignancies. Methods: We utilized the publicly available Medicare Part D provider utilization and payment database from 2015 to 2019. We extracted drug prices (using generic names) for commonly used targeted oral anticancer agents for lung, breast, and prostate cancer. The primary outcome was the correlation of average change in Medicare spending per dosage unit among the multiple brand-name medications within each class available. We additionally calculated compound annual growth rates (CAGRs) [i.e. mean annual growth rates over a specified period of time] for medication costs within each class, and compared it with the consumer price index (a measure of the average change over time in the prices of consumer items). Results: The study included 6 EGFR inhibitors (1 generic), 5 ALK inhibitors, 2 BRAF inhibitors, 3 hormonal agents (1 generic), 3 CDK4/6 inhibitors, 2 PARP inhibitors, and 7 anti-androgen agents (2 generic). The median (range) Pearson correlation coefficient values for drugs within each class were 0.967 (0.915-0.978) for EGFRi, 0.981 (0.966-0.989) for ALKi, 0.996 for BRAFi, 0.994 (0.992-0.999) for CDK4/6i, 0.855 for PARPi, and 0.442 (-0.522-0.962) for anti-androgens. Except for anti-androgens, all other drug classes showed strong linear association in price increase between two drugs within the same-class. A coefficient could not be calculated for therapies with 2 or fewer data points ( i.e., generic erlotinib, dacomitinib, generic abiraterone, apalutamide, and darolutamide). There was no significant correlation between expenditure for anti-estrogen agents. The median (range) CAGRs in costs over this 5-year period were: were 4.56% for EGFRi, 6.40% for ALKi, 2.58% for BRAFi, 5.48% for hormonal agents, 5.21% for CDK4/6i, 27.29% for PARPi, and 34.8% for anti-androgen agents. Conclusions: The median CAGR in costs for modern oral precision driven cancer therapeutic classes mostly outpaced CPI (2.26%/year), and the average inflation rate (1.90%/year). Increase in cost within the same class should be weighed against incremental clinical benefit for the patients. For most classes despite there being multiple agents, the rise in drug expenditures correlated closely, calling into question the true value of within class competition. There is an urgent need for drug pricing reform given the average expenditure of Medicare part D, and ultimately out of pocket costs for our patients with cancer continues to trend upwards. Increased advocacy efforts are needed to ensure precision therapeutics remains an attainable and sustainable goal.

scholarly journals Private Provision of Social Insurance: Drug-Specific Price Elasticities and Cost Sharing in Medicare Part D

2018 ◽  
Vol 10 (3) ◽  
pp. 122-153 ◽  
Author(s):  
Liran Einav ◽  
Amy Finkelstein ◽  
Maria Polyakova
Keyword(s):  
Cost Sharing ◽  
Social Insurance ◽  
Medicare Part D ◽  
Medicare Part ◽  
Elastic Demand ◽  
Part D ◽  
Price Elasticities ◽  
The Cost ◽  
Substantial Heterogeneity ◽  
Do So

We explore how private drug plans set cost sharing in the context of Medicare Part D. While publicly provided drug coverage typically involves uniform cost sharing across drugs, we document substantial heterogeneity in the cost sharing for different drugs within privately provided plans. We also document that private plans systematically set higher consumer cost sharing for drugs or classes associated with more elastic demand; to do so, we estimate price elasticities of demand across more than 150 drugs and across more than 100 therapeutic classes. We conclude by discussing the various channels that likely affect private plans’ cost-sharing decisions. (JEL G22, H51, I13, I18, L11, L65)

Abstract 17410: A Multiperspective Analysis of the Influence of Medicare Part D on the Cost-effectiveness of Dabigatran versus Warfarin

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Brian M Salata ◽  
David W Hutton ◽  
Deborah A Levine ◽  
James B Froehlich ◽  
Geoffrey D Barnes
Keyword(s):  
Atrial Fibrillation ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D ◽  
Patient’S Perspective ◽  
Life Years ◽  
The Cost ◽  
Quality Adjusted Life

Introduction: Dabigatran and warfarin have been shown to be non-inferior for stroke prevention in atrial fibrillation (AF). We aimed to assess the cost perspectives of each payer (Medicare and patient) in relation to administration, monitoring and adverse outcomes for each medication. Hypothesis: We hypothesize that dabigatran 150 mg BID will be more cost-effective when compared to warfarin for both payers (Medicare and patient) regardless of Medicare Part D coverage. Methods: Using a Markov model, we performed a decision analysis comparing two treatment strategies in patients 65 years of age and older with AF: adjusted-dose warfarin and dabigatran 150 mg twice daily in Medicare patients with CHADS2 scores ≥ 1. Results are listed in 2013 US dollars, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). Patient movement between health states was modeled using 1-month cycles for 35 years or until death. Cost-effectiveness therapies were selected using a willingness to pay threshold of $50,000 per quality-adjusted life year gained. Results: For patients with Medicare Part D coverage, Quality-adjusted life expectancy was 10.74 QALYs with warfarin and 11.22 QALYs with 150 mg dabigatran BID. From Medicare’s perspective, total average costs were $59,684 and $59,284 for warfarin as well as $76,237 and $45,421 for dabigatran, in patients with and without Part D coverage, respectively. From Medicare’s perspective, the ICER comparing dabigatran with warfarin was $34,707 and -$29,065, for patients with and without Part D coverage, respectively. From the patient’s perspective, total costs were $33,466 and $33,866 for warfarin as well as $28,876 and $59,692 for dabigatran, in patients with and without Part D coverage, respectively. From the patient’s perspective, the ICER comparing dabigatran with warfarin was -$9,624 and $54,147, for patients with and without Part D coverage, respectively. Conclusions: In patients ≥ 65 years old with nonvalvular atrial fibrillation (NVAF) and at increased risk of stroke (CHAD2 score = 2), dabigatran 150 mg BID is more cost-effective for both Medicare and the patient, except for individual patients without Medicare Part D coverage.

scholarly journals Medicare Part D: Are Insurers Gaming the Low Income Subsidy Design?

2015 ◽  
Vol 105 (4) ◽  
pp. 1547-1580 ◽  
Author(s):  
Francesco Decarolis
Keyword(s):  
Low Income ◽  
Instrumental Variable ◽  
Medicare Part D ◽  
Consumer Welfare ◽  
Medicare Part ◽  
Large Share ◽  
Part D ◽  
Program Cost ◽  
Level Data ◽  
The Cost

This paper shows how in Medicare Part D insurers' gaming of the subsidy paid to low-income enrollees distorts premiums and raises the program cost. Using plan-level data from the first five years of the program, I find multiple instances of pricing strategy distortions for the largest insurers. Instrumental variable estimates indicate that the changes in a concentration index measuring the manipulability of the subsidy can explain a large share of the premium growth observed between 2006 and 2011. Removing this distortion could reduce the cost of the program without worsening consumer welfare.(JEL G22, H51, I13, I18)

Medicare Part D Has Side Effects For Physicians

2006 ◽  
Vol 39 (4) ◽  
pp. 1-10
Author(s):  
MARY ELLEN SCHNEIDER
Keyword(s):  
Side Effects ◽  
Medicare Part D ◽  
Medicare Part ◽  
Part D
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