Medicare Part D spending for the 10 costliest oral anticancer drugs.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 52-52
Author(s):  
Kaitlyn McBride ◽  
Sophie Snyder
Keyword(s):  
Prescription Drugs ◽  
Cost Effective ◽  
Medicare Part D ◽  
Medicare Part ◽  
Drug Spending ◽  
Part D ◽  
Annual Total ◽  
Wholesale Acquisition Cost

52 Background: Novel oral targeted drugs are being used more frequently to treat many cancers and have substantially improved clinical and survival outcomes. Due to the long treatment durations of many of these medications, which are given continuously until patient progression, per-patient lifetime costs can be high. This study aimed to identify the ten oral anticancer therapies with the highest annual Medicare Part D spending. Methods: Descriptive statistics were performed on data obtained from the CMS Medicare Part D Drug Spending Dashboard and IBM Micromedex RED BOOK, from 2018-2019. Medicare Part D dashboard includes total and average drug spending, and number of beneficiaries utilizing the drug. RED BOOK provides current and historical average wholesale pricing (AWP) data for all prescription drugs. The wholesale acquisition cost (WAC) was calculated from the AWP to evaluate trends in price. We identified the ten anticancer brand-name medications in 2019 with the highest annual Part D spending and reported changes in average spending and number of unique beneficiaries for each drug from 2018-2019. Results: In 2019, Revlimid had the highest annual total Part D spending at $4.6 billion, followed by Imbruvica with $2.4 billion; these drugs also had the greatest number of beneficiary utilizers. From 2018-2019, change in average spending per dosage unit was greatest for Zytiga (34%), however among all drugs, average spending per beneficiary in 2019 was lowest for this medication ($58,074). From 2018-2019, WAC and average spending per dosage unit increased for all of the top ten drugs, as well as the number of total beneficiaries utilizing each drug, except for Zytiga and Sprycel. Conclusions: Oral anticancer therapies provide high value for patients, including improved quality of life and survival. Annual costs for these drugs are high, however spending on inpatient hospital services remains a greater share of total Medicare spending in aggregate and on a per beneficiary basis. Emerging one-time curative treatments for cancer may prove most cost-effective in the long-term by eliminating the need for continuous medication use and hospital care, while improving patient outcomes.[Table: see text]

Medicare Part D and Long-Term Care: A Systematic Review of Quantitative and Qualitative Evidence

Drugs & Aging ◽  
2013 ◽  
Vol 30 (9) ◽  
pp. 701-720 ◽  
Author(s):  
Camilla B. Pimentel ◽  
Kate L. Lapane ◽  
Becky A. Briesacher
Keyword(s):  
Systematic Review ◽  
Long Term Care ◽  
Medicare Part D ◽  
Medicare Part ◽  
Term Care ◽  
Part D ◽  
Qualitative Evidence

Impact of Medicare Part D on out-of-pocket drug costs and utilization for patients with cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 275-275
Author(s):  
Sheetal Mehta Kircher ◽  
Michael Johansen ◽  
Matthew M. Davis
Keyword(s):  
Prescription Drug ◽  
Prescription Drugs ◽  
Medicare Part D ◽  
Drug Costs ◽  
Medicare Part ◽  
Prescription Drug Coverage ◽  
Medicare Beneficiaries ◽  
Part D ◽  
Patients With Cancer ◽  
Per Capita

275 Background: Medicare Part D was designed to reduce out of pocket (OOP) costs for Medicare beneficiaries, but the extent to which this occurred for patients with cancer has not been measured. The aim of this study is to quantify the impact of Part D eligibility on OOP cost for prescription drugs and utilization for cancer patients. Methods: Differences-in-differences analyses were used to estimate the effects of Medicare Part D eligibility on OOP drug costs, by comparing 4 year periods before and after Part D implementation. Analyses were based on data from the publicly available Medical Expenditure Panel Survey, a nationally representative, all-payer sample of the United States non-institutionalized civilian population. Our analysis compared per-capita OOP burden between Medicare beneficiaries (age 65+) with cancer to near-elderly individuals age 55-64 years old with cancer. Results: 2,077 near-elderly individuals with cancer and 4,723 individuals with Medicare and cancer were included (total n=6,800), representing over 85 million people. Prescription drug coverage increased among individuals with Medicare from before Part D (39%) to after (65%); in contrast, prescription drug coverage among the near-elderly remained stable before vs. after Part D (82.4% vs. 81.4%). The mean per-capita OOP cost for Medicare beneficiaries with cancer before Part D was $1,111 (SE ±45) and decreased to $694 (±35) after implementation of Medicare Part D—a decline of 37%. Compared with changes in OOP drug costs for non-elderly patients with cancer over the same period, implementation of Medicare Part D was associated with a further reduction of $286 per person. OOP costs for cancer-associated drugs (i.e., antineoplastic, pain medications, anti-emetics) accounted for 6.5-11.1% of the total OOP cost with no significant trends between 2002-2010. Conclusions: The implementation of Medicare D has significantly reduced OOP prescription drug costs for seniors with cancer, beyond trends observed for younger patients. Considering prescription drugs for all medical conditions, cancer associated drugs compose a minority of the cost, highlighting that cancer patients have many comorbid conditions contributing to overall costs.

Osteoporosis Medication Use: A Comparison of Elderly Females Living in Long-term Care Facilities Versus Community Dwellers

2019 ◽  
Vol 34 (2) ◽  
pp. 109-126
Author(s):  
F. Ellen Loh ◽  
Bruce Stuart ◽  
Deborah Sturpe ◽  
Amy Davidoff ◽  
Eberechukwu Onukwugha ◽  
...  
Keyword(s):  
Long Term Care ◽  
Medication Use ◽  
Medicare Part D ◽  
Medicare Part ◽  
Evidence Based ◽  
Osteoporosis Medication ◽  
Term Care ◽  
Part D ◽  
Community Dwellers

OBJECTIVE: This study compares patterns of evidence-based osteoporosis medication use among females in community and long-term care settings enrolled in Medicare Part D.<br/> DESIGN: Pooled cross-sectional study.<br/> SETTING: Medicare beneficiaries enrolled in Medicare Parts A and B, and Part D stand-alone prescription drug plans from January 1, 2006, through December 31, 2008, or death.<br/> PARTICIPANTS: Female Medicare Part D enrollees 70 years of age and older with osteoporosis or prior hip fracture.<br/> INTERVENTIONS: NA.<br/> MAIN OUTCOME MEASUREMENTS: Use of bisphosphonates, calcitonin, teriparatide, and raloxifene was tracked by residential status over the three-year period.<br/> RESULTS: The study sample comprised 96,408 female Part D enrollees with osteoporosis. Prevalence of evidence-based medication use was 42.3% in 2006 and dropped slightly to 40.4% in 2008. In unadjusted comparisons, long-term care residents were significantly less likely to use any osteoporosis medication compared with community dwellers (40.6% vs. 53.1%). After adjustment for differences in individual characteristics, utilization was still lower among long-term care residents (relative risk [RR] = 0.89, 95% confidence interval [CI] 0.87-0.91). Bisphosphonates were the top choice among medication users, but were prescribed much less often to long-term care residents (RR = 0.79, 95% CI 0.75-0.83) compared with community residents.<br/> CONCLUSION: Prevalence of evidence-based osteoporosis medication use is low in older women enrolled in Part D whether community-dwelling or long-term care residents, but long-term nursing facility residents are more likely to be treated with nonbisphosphonates. Many events that may affect osteoporosis medication use occurred after 2008; therefore, future studies using more recent data are warranted to examine osteoporosis medication use after 2008.

The Long-Term Impact of Price Controls in Medicare Part D

2017 ◽  
Vol 20 (2) ◽  
Author(s):  
Gigi Moreno ◽  
Emma van Eijndhoven ◽  
Jennifer Benner ◽  
Jeffrey Sullivan
Keyword(s):  
Medicare Part D ◽  
The United States ◽  
Status Quo ◽  
Medicare Part ◽  
Price Setting ◽  
Health Administration ◽  
Part D ◽  
Price Controls ◽  
The Status

Abstract Price controls for prescription drugs are once again at the forefront of policy discussions in the United States. Much of the focus has been on the potential short-term savings – in terms of lower spending – although evidence suggests price controls can dampen innovation and adversely affect long-term population health. This paper applies the Health Economics Medical Innovation Simulation, a microsimulation of older Americans, to estimate the long-term impacts of government price setting in Medicare Part D, using pricing in the Federal Veterans Health Administration program as a proxy. We find that VA-style pricing policies would save between $0.1 trillion and $0.3 trillion (US$2015) in lifetime drug spending for people born in 1949–2005. However, such savings come with social costs. After accounting for innovation spillovers, we find that price setting in Part D reduces the number of new drug introductions by as much as 25% relative to the status quo. As a result, life expectancy for the cohort born in 1991–1995 is reduced by almost 2 years relative to the status quo. Overall, we find that price controls would reduce lifetime welfare by $5.7 to $13.3 trillion (US$2015) for the US population born in 1949–2005.

scholarly journals The Response of Drug Expenditure to Nonlinear Contract Design: Evidence from Medicare Part D *

2015 ◽  
Vol 130 (2) ◽  
pp. 841-899 ◽  
Author(s):  
Liran Einav ◽  
Amy Finkelstein ◽  
Paul Schrimpf
Keyword(s):  
Medicare Part D ◽  
Drug Expenditure ◽  
Medicare Part ◽  
Simple Extension ◽  
Drug Spending ◽  
Baseline Model ◽  
Part D ◽  
Insurance Contracts ◽  
Donut Hole ◽  
Using Data

Abstract We study the demand response to nonlinear price schedules using data on insurance contracts and prescription drug purchases in Medicare Part D. We exploit the kink in individuals’ budgets set created by the famous “donut hole,” where insurance becomes discontinuously much less generous on the margin, to provide descriptive evidence of the drug purchase response to a price increase. We then specify and estimate a simple dynamic model of drug use that allows us to quantify the spending response along the entire nonlinear budget set. We use the model for counterfactual analysis of the increase in spending from “filling” the donut hole, as will be required by 2020 under the Affordable Care Act. In our baseline model, which considers spending decisions within a single year, we estimate that filling the donut hole will increase annual drug spending by about $150, or about 8 percent. About one-quarter of this spending increase reflects anticipatory behavior, coming from beneficiaries whose spending prior to the policy change would leave them short of reaching the donut hole. We also present descriptive evidence of cross-year substitution of spending by individuals who reach the kink, which motivates a simple extension to our baseline model that allows—in a highly stylized way—for individuals to engage in such cross-year substitution. Our estimates from this extension suggest that a large share of the $150 drug spending increase could be attributed to cross-year substitution, and the net increase could be as little as $45 a year.

scholarly journals The Medium-Term Impact of Medicare Part D on Pharmaceutical Prices

2011 ◽  
Vol 101 (3) ◽  
pp. 387-392 ◽  
Author(s):  
Mark G Duggan ◽  
Fiona Scott Morton
Keyword(s):  
Prescription Drugs ◽  
Medicare Part D ◽  
Medicare Part ◽  
First Year ◽  
Medium Term ◽  
Part D ◽  
The Third ◽  
Using Data ◽  
Pharmaceutical Prices ◽  
Bounce Back

Medicare Part D began coverage of prescription drugs in 2006. Using data from the first year of the program we found that Part D reduced pharmaceutical prices for Medicare recipients, with these effects driven by enrollees previously without drug coverage. In this paper we extend our analysis through 2009, the fourth year of the program, to investigate whether plans continued to extract price concessions in return for favorable formulary placement, or if consumer inertia or other factors caused prices to bounce back after their initial decline. We find price declines persisted through at least the third year of the program.

Sign in / Sign up

Export Citation Format

Share Document