Cost Comparison of Antiseizure Medications Under Medicare Part D and Medicaid
Abstract number :
2.494
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2024
Submission ID :
1663
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Sarah Otterman, MD MS – Medical College of Wisconsin
Tengizi Mtchedlidze, BEc – University of Economics in Bratislava
Pradeep Javarayee, MD MBA – Medical College of Wisconsin
Tasmia Amjad, BS – Medical College of Wisconsin
Rationale: This study investigates the sustained price disparities between branded and generic medications, analyzing the financial impact of aligning their costs. It aims to assess potential savings and enhance medication affordability for Medicare Part D and Medicaid beneficiaries
Methods: This study employs the Medicare Part D and Medicaid by Drug Dataset to analyze drug spending from 2012 to 2022, assessing the impact of the Affordable Care Act on pricing trends. Focusing on anti-seizure medications (ASMs), the research will track spending, claims, dosage, and price trends for both branded and generic drugs. Costs will be adjusted for inflation using the Consumer Price Index for Medicinal Drugs - Seasonally Adjusted (CPI-MDS).
Results: In Medicaid, spending on branded ASMs peaked at $2.23 billion in 2021 compared to generics at $0.69 billion in 2012. The number of claims for generics saw a steady increase, reaching 26.99 million in 2017. Dosage units for branded medications in Medicaid fluctuated slightly, ending at 0.2 billion units in 2022, while generics peaked at 2.36 billion units in 2021. Meanwhile, Medicare spending on branded ASMs reached a high of $2.07 billion in 2021, with generics at $1.59 billion in 2014. Claims for branded medications in Medicare peaked at 1.53 million in 2021, while for generics remained robust, maintaining around 47.86 million claims in 2015, demonstrating a higher usage of generic medications across both programs, reflecting broader trends in pharmaceutical healthcare spending. (Figures 2A and 2B). In Medicaid, spending per unit for branded ASMs rose from $6.5 to $17.9, while generic ASMs increased from $1.0 to $3.1. In Medicare, spending per unit on branded ASM increased from $7.4 to $20.1, with generics rising from $1.1 to $4.9 (Figure 5A and 5B). In Medicaid and Medicare, the price gap between brand and generic ASMs widened over time (Figure 1A and 1B). Levetiracetam went from 825.00% to 2710.81% per unit. Medicare exhibited even more pronounced differences. For generic medications in Medicaid, the $10-50 category decreased from 6.9% to 5.3%, while the $1-10 range increased from 25% to 34.2%. Brand medications in Medicaid saw a significant shift towards higher prices, with the $10-50 range growing dramatically from 3.4% to 52.5%. In Medicare, generic medications in the $10-50 range decreased from 3.4% to 2.7%, while the $1-10 category increased from 25% to 37.8% (Figures 3A and 3B)
Conclusions: The analysis highlights significant disparities between spending on branded versus generic anti-seizure medications (ASMs) in Medicaid and Medicare, with branded costs rising sharply compared to the more stable prices of generics. Despite the cost-effectiveness of generics, their utilization has decreased, suggesting impacts from prescribing habits and policy changes. The widening price gap, particularly for medications like primidone and levetiracetam, underscores the urgency for policies promoting generic use to help control escalating healthcare costs and improve access to essential treatments.
Funding: This study received no funding.
Health Services (Delivery of Care, Access to Care, Health Care Models)