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Hodzic-Santor B, Sacks CA, Van Bakel T, Fralick M. Identifying drugs with the greatest increases and decreases in spending per beneficiary using Medicare Part D: A cross-sectional study. PLoS One 2023; 18:e0281076. [PMID: 36758003 PMCID: PMC9910683 DOI: 10.1371/journal.pone.0281076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/15/2023] [Indexed: 02/10/2023] Open
Abstract
IMPORTANCE In the US, there are no effective regulations controlling how much the price of a medication can increase. A patchwork of studies examining the reasons for soaring prices has focused on medications that have received considerable media attention, like insulin, epinephrine, and colchicine. OBJECTIVE To identify the 50 medications with the greatest increase in average spending per beneficiary and the 50 medications with the greatest decrease in average spending per beneficiary, and to identify the factors associated with spending increases. DESIGN, PARTICIPANTS This cross-sectional study used publicly available data from the Medicare Part D Prescription Drug Program from 2014 to 2020. We included drugs dispensed to > 1000 beneficiaries in each study year and excluded those primarily administered intravenously. MAIN MEASURES Percentage change in average spending per beneficiary from 2014 to 2020 was calculated for each drug. For each drug, we extracted the number of beneficiaries, the number of manufacturers, and the drug-specific total annual spending reported in the Medicare Part D data set. An online database search was conducted to identify the primary clinical indication, the availability of any generic versions, and the date of FDA approval for each drug. RESULTS The 50 medications with the greatest increase in spending per beneficiary had a median increase of 362.4% (interquartile range [IQR]: 286.6%-563.0%), with a cumulative spending of almost $5 billion in 2020 alone. Most drugs with the greatest increases in spending per beneficiary had generic versions available (68%) and were approved by the FDA over 10 years ago (66%). Medications with the greatest increase in spending per beneficiary had a median of 1 manufacturer (IQR: 1-2), while medications with the greatest decrease in spending per beneficiary had a median of 9.5 manufacturers (IQR: 5-14). CONCLUSIONS This study identified rapidly increasing costs of medications under Medicare Part D. Our findings demonstrate that off-patent medications can skyrocket in price, especially when there are few manufacturers of a given medication.
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Affiliation(s)
- Benazir Hodzic-Santor
- Division of General Internal Medicine, Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
| | - Chana A. Sacks
- Division of General Internal Medicine and Mongan Institute, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Tamara Van Bakel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Michael Fralick
- Division of General Internal Medicine, Department of Medicine, Sinai Health System, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- * E-mail:
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Watane A, Kalavar M, Reyes J, Yannuzzi NA, Sridhar J. The Effect of Market Competition on the Price of Topical Eye Drops. Semin Ophthalmol 2022; 37:42-48. [PMID: 33780301 PMCID: PMC8478971 DOI: 10.1080/08820538.2021.1906918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE To describe the relationship between the number of Federal Drug Administration (FDA)-approved manufacturers and the price change of generic and branded topical eye drops. METHODS Retrospective analysis of topical eye drop medications with formulations listed in the FDA Orange Book and the National Average Drug Acquisition Cost database from 2013 to 2017. RESULTS The most frequently prescribed generic topical drugs were glaucoma medications (34%), antimicrobials (32%), anti-inflammatories (24%), mydriatics (5%), and anesthetics (5%). The most frequently prescribed branded topical drugs were anti-inflammatories (45%), glaucoma medications (32%), antimicrobials (21%) and dry eye medications (3%). From 2013 to 2017, generic eye drops had a median price decrease of 20% (IQR 32%) while branded eye drops had a median price increase of 44% (IQR 28%) (P < .001). A significant inverse association was identified between the price change of generic eye drops and the total number of all manufacturers (r = -.41, P = .010), generic drug manufacturers (r = -.32, P = .0496), and alternative branded drug manufacturers (r = -.57, P = .002). There was no significant association between the price change of branded eye drops and number of manufacturers. Glaucoma (r = -.58, P = .039) and anti-inflammatory (r = -.69, P = .047) eye drops also had significant inverse associations with the number of generic manufacturers. CONCLUSION From 2013 to 2017, the price of generic eye drops decreased whereas the price of branded eye drops increased. Market competition was significantly inversely associated with price changes of generic eye drops but not branded eye drops.
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Affiliation(s)
- Arjun Watane
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136
| | - Meghana Kalavar
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136
| | - Joshua Reyes
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136
| | - Jayanth Sridhar
- Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine. 900 NW 17 Street. Miami, FL 33136
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Guharoy R, Noviasky J. Executive Order on Ensuring Essential Medicines-All Bark, No Bite? Mayo Clin Proc 2021; 96:1714-1717. [PMID: 34218853 DOI: 10.1016/j.mayocp.2020.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Roy Guharoy
- Department of Pharmacy, Baptist Health, Montgomery, AL; Infectious Diseases, University of Massachusetts Medical School, Worcester, MA.
| | - John Noviasky
- Departments of Pharmacy and Medicine, SUNY-Upstate Medical University, Syracuse, NY
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Patel AN, Kesselheim AS, Rome BN. Frequency Of Generic Drug Price Spikes And Impact On Medicaid Spending. Health Aff (Millwood) 2021; 40:779-785. [PMID: 33939520 DOI: 10.1377/hlthaff.2020.02020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Although generic drugs are typically inexpensive, rising prices among some generic drugs in recent years have raised concern. Using Medicaid data, we found that one in five generic drugs sold in the US experienced a price spike (defined as a doubling in price over the course of one year) initiated by at least one manufacturer during the period 2014-17. There was a trend toward fewer price spikes each year, from 7.8 percent of drugs in 2014 to 5.8 percent in 2017. Among drugs experiencing price spikes, 51 percent were injected products, 64 percent had three or fewer manufacturers, and 18 percent were in shortage at the time of the spike. Generic drug price spikes cost Medicaid $1.5 billion during 2014-16, representing 4.2 percent of all Medicaid generic drug spending in that period. The trend toward fewer price spikes over time may be due to increased public scrutiny and regulatory actions. However, price spikes can be very costly, and additional policies are needed to both ensure adequate competition and control prices among generic drugs.
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Affiliation(s)
- Aayan N Patel
- Aayan N. Patel is a researcher in the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, in Boston, Massachusetts. At the time this work was performed, he was a researcher in the Department of Biology, University of Nevada, Reno, in Reno, Nevada
| | - Aaron S Kesselheim
- Aaron S. Kesselheim is a professor of medicine and the director of the Program on Regulation, Therapeutics, and Law in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School
| | - Benjamin N Rome
- Benjamin N. Rome is an instructor of medicine in the Program on Regulation, Therapeutics, and Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School
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Beall RF, Quinn AE, Kesselheim AS, Tessema FA, Sarpatwari A. Generic Competition for Drugs Treating Rare Diseases. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2020; 48:789-795. [PMID: 33404340 DOI: 10.1177/1073110520979391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Reed F Beall
- Reed F. Beall, Ph.D., is an assistant professor in health care policy in the Department of Community Health Sciences at the Cumming School of Medicine and at the O'Brien Institute for Public Health at the University of Calgary. Amity E. Quinn, Ph.D., is a post-doctoral fellow in health economics in the Department of Community Health Sciences at the at the University of Calgary. Aaron S. Kesselheim, M.D., J.D, M.P.H., is a professor of medicine and director of the Program On Regulation, Therapeutics, And Law (PORTAL) at Brigham and Women's Hospital and Harvard Medical School. At the time of the study, Frazer A. Tessema, B.A., was a research assistant with PORTAL at Brigham and Women's Hospital and Harvard Medical School. Ameet Sarpatwari, Ph.D., J.D., is an assistant professor of medicine and assistant director of PORTAL at Brigham and Women's Hospital and Harvard Medical School
| | - Amity E Quinn
- Reed F. Beall, Ph.D., is an assistant professor in health care policy in the Department of Community Health Sciences at the Cumming School of Medicine and at the O'Brien Institute for Public Health at the University of Calgary. Amity E. Quinn, Ph.D., is a post-doctoral fellow in health economics in the Department of Community Health Sciences at the at the University of Calgary. Aaron S. Kesselheim, M.D., J.D, M.P.H., is a professor of medicine and director of the Program On Regulation, Therapeutics, And Law (PORTAL) at Brigham and Women's Hospital and Harvard Medical School. At the time of the study, Frazer A. Tessema, B.A., was a research assistant with PORTAL at Brigham and Women's Hospital and Harvard Medical School. Ameet Sarpatwari, Ph.D., J.D., is an assistant professor of medicine and assistant director of PORTAL at Brigham and Women's Hospital and Harvard Medical School
| | - Aaron S Kesselheim
- Reed F. Beall, Ph.D., is an assistant professor in health care policy in the Department of Community Health Sciences at the Cumming School of Medicine and at the O'Brien Institute for Public Health at the University of Calgary. Amity E. Quinn, Ph.D., is a post-doctoral fellow in health economics in the Department of Community Health Sciences at the at the University of Calgary. Aaron S. Kesselheim, M.D., J.D, M.P.H., is a professor of medicine and director of the Program On Regulation, Therapeutics, And Law (PORTAL) at Brigham and Women's Hospital and Harvard Medical School. At the time of the study, Frazer A. Tessema, B.A., was a research assistant with PORTAL at Brigham and Women's Hospital and Harvard Medical School. Ameet Sarpatwari, Ph.D., J.D., is an assistant professor of medicine and assistant director of PORTAL at Brigham and Women's Hospital and Harvard Medical School
| | - Frazer A Tessema
- Reed F. Beall, Ph.D., is an assistant professor in health care policy in the Department of Community Health Sciences at the Cumming School of Medicine and at the O'Brien Institute for Public Health at the University of Calgary. Amity E. Quinn, Ph.D., is a post-doctoral fellow in health economics in the Department of Community Health Sciences at the at the University of Calgary. Aaron S. Kesselheim, M.D., J.D, M.P.H., is a professor of medicine and director of the Program On Regulation, Therapeutics, And Law (PORTAL) at Brigham and Women's Hospital and Harvard Medical School. At the time of the study, Frazer A. Tessema, B.A., was a research assistant with PORTAL at Brigham and Women's Hospital and Harvard Medical School. Ameet Sarpatwari, Ph.D., J.D., is an assistant professor of medicine and assistant director of PORTAL at Brigham and Women's Hospital and Harvard Medical School
| | - Ameet Sarpatwari
- Reed F. Beall, Ph.D., is an assistant professor in health care policy in the Department of Community Health Sciences at the Cumming School of Medicine and at the O'Brien Institute for Public Health at the University of Calgary. Amity E. Quinn, Ph.D., is a post-doctoral fellow in health economics in the Department of Community Health Sciences at the at the University of Calgary. Aaron S. Kesselheim, M.D., J.D, M.P.H., is a professor of medicine and director of the Program On Regulation, Therapeutics, And Law (PORTAL) at Brigham and Women's Hospital and Harvard Medical School. At the time of the study, Frazer A. Tessema, B.A., was a research assistant with PORTAL at Brigham and Women's Hospital and Harvard Medical School. Ameet Sarpatwari, Ph.D., J.D., is an assistant professor of medicine and assistant director of PORTAL at Brigham and Women's Hospital and Harvard Medical School
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Gupta R, Shah ND, Ross JS. Generic Drugs in the United States: Policies to Address Pricing and Competition. Clin Pharmacol Ther 2019; 105:329-337. [PMID: 30471089 DOI: 10.1002/cpt.1314] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/15/2018] [Indexed: 02/06/2023]
Abstract
The cost of prescription drugs in the United States continues to be a source of concern for patients, caregivers, and policymakers. Drug prices typically decline rapidly once generic drugs receive US Food and Drug Administration (FDA) approval and enter the market, but the past decade has witnessed rising costs and shortages of generic drugs. We describe the strategies used by brand-name manufacturers to undermine generic competition and the reasons underlying the price increases of off-patent drugs, some of which continue to lack any competition from generic versions, and others that have increased in price despite having generic versions. We discuss the FDA's role in addressing drug prices and promoting competition, including recent agency policies to modify its process of reviewing generic drug applications and to prioritize applications for off-patent drugs with few competitors. We also examine proposed policy solutions and research areas that could help address the price increases of off-patent drugs.
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Affiliation(s)
- Ravi Gupta
- Department of Medicine, Johns Hopkins Hospital and Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Nilay D Shah
- Division of Health Care Policy and Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Joseph S Ross
- Department of Medicine, Section of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Health Policy and Management, Yale University School of Public Health, New Haven, Connecticut, USA.,Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
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Dave CV, Pawar A, Fox ER, Brill G, Kesselheim AS. Predictors of Drug Shortages and Association with Generic Drug Prices: A Retrospective Cohort Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1286-1290. [PMID: 30442275 DOI: 10.1016/j.jval.2018.04.1826] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 04/18/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prescription drug shortages can disrupt essential patient care and drive up drug prices. OBJECTIVE To evaluate some predictors of shortages within a large cohort of generic drugs in the United States and to determine the association between drug shortages and changes in generic drug prices. METHODS This was a retrospective cohort study. Outpatient prescription claims from commercial health plans between 2008 and 2014 were analyzed. Seven years of data were divided into fourteen 6-month periods; the first period was designated as the baseline period. The first model estimated the probability of experiencing a drug shortage using drug-specific competition levels, market sizes, formulations (e.g., capsules), and drug prices as predictors. The second model estimated the percentage change in drug prices from baseline on the basis of drug shortage duration. RESULTS From 1.3 billion prescription claims, a cohort of 1114 generic drugs was identified. Low-priced generic drugs were at a higher risk for drug shortages compared with medium- and high-priced generic drugs, with odds ratios of 0.60 (95% confidence interval [CI] 0.44-0.82) and 0.72 (95% CI 0.52-0.99), respectively. Compared with periods of no shortage, drug shortages lasting less than 6 months, 6 to 12 months, 12 to 18 months, and at least 18 months had corresponding price increases of 6.0% (95% CI 4.7-7.4), 10.9% (95% CI 8.5-13.4), 14.2% (95% CI 10.6-17.9), and 14.0% (95% CI 9.1-19.2), respectively. CONCLUSIONS Study findings may not be generalizable to drugs that became generic after 2008 or those commonly used in an inpatient setting. The lowest priced drugs are at a substantially elevated risk of experiencing a drug shortage. Periods of drug shortages were associated with modest increases in drug prices.
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Affiliation(s)
- Chintan V Dave
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ajinkya Pawar
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Erin R Fox
- University of Utah Health Care Drug Information Service, University of Utah, Salt Lake City, UT, USA
| | - Gregory Brill
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Hedlund NG, Isgor Z, Zwanziger J, Rondelli D, Crawford SY, Hynes DM, Powell LM. Drug Shortage Impacts Patient Receipt of Induction Treatment. Health Serv Res 2018; 53:5078-5105. [PMID: 30198560 DOI: 10.1111/1475-6773.13028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Examine the impact of the 2011 shortage of the drug cytarabine on patient receipt and timeliness of induction treatment for Acute Myeloid Leukemia (AML). STUDY DESIGN A retrospective cohort was utilized to examine odds of receipt of inpatient induction chemotherapy and time to first dose across major (N = 105) and moderate (N = 316) shortage time periods as compared to a nonshortage baseline (N = 1,147). DATA COLLECTION/EXTRACTION METHODS De-identified patient data from 2008 to 2011 Surveillance, Epidemiology, and End Results (SEER) were linked to 2007-2013 Medicare claims and 2007-2013 Hospital Characteristics. PRINCIPAL FINDINGS Compared to prior nonshortage time period, patients diagnosed during a major drug shortage were 47 percent less likely (p < .05) to receive inpatient chemotherapy within 14 days of diagnosis. Patients who were younger, had a lower Charlson Comorbidity score, and for whom AML was a first primary cancer were prioritized across all periods. CONCLUSIONS Period of major shortage of a generic oncolytic, without an equivalent therapeutic substitute, reduced timely receipt of induction chemotherapy treatment. More favorable economic and regulatory policies for generic drug suppliers might result in greater availability of essential, older generic drug products that face prolonged or chronic shortage.
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Affiliation(s)
- Nancy G Hedlund
- School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Zeynep Isgor
- School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Jack Zwanziger
- School of Public Health, University of Illinois at Chicago, Chicago, IL
| | - Damiano Rondelli
- Department of Medicine, University of Illinois at Chicago -UI Health, UIC Center for Global Health, COM, Chicago, IL
| | - Stephanie Y Crawford
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL
| | - Denise M Hynes
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR.,VA Portland Healthcare System, Portland, OR.,Department of Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Lisa M Powell
- School of Public Health, University of Illinois at Chicago, Chicago, IL
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Gupta R, Bollyky TJ, Cohen M, Ross JS, Kesselheim AS. Affordability and availability of off-patent drugs in the United States-the case for importing from abroad: observational study. BMJ 2018; 360:k831. [PMID: 29555641 PMCID: PMC5858606 DOI: 10.1136/bmj.k831] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate whether off-patent prescription drugs at risk of sudden price increases or shortages in the United States are available from independent manufacturers approved in other well regulated settings around the world. DESIGN Observational study. SETTING Off-patent drugs in the USA and approved by the Food and Drug Administration, up to 10 April 2017. STUDY COHORT Novel tablet or capsule prescription drugs approved by the FDA since 1939 that were no longer protected by patents or other market exclusivity and had up to three generic versions. MAIN OUTCOME MEASURES Number of additional manufacturers that had obtained approval from any of seven non-US regulators with similar standards (European Medicines Agency (European Union), HealthCanada (Canada), Therapeutic Goods Association (Australia), Medsafe (New Zealand), Swissmedic (Switzerland), Medicines Control Council (South Africa), and the Israel Health Ministry). Association with drug characteristics including US orphan drug designation for drugs treating rare diseases, World Health Organization essential medicine designation, treatment area, drug product complexity (that is, with attributes that could complicate establishing bioequivalence or manufacturing), and total Medicaid spending in 2015. RESULTS Of 170 eligible study drugs, more than half (109, 64%) had at least one manufacturer approved by a non-US regulator and 32 (19%) had four or more. Among 44 (26%) drugs with no FDA approved generic versions, 21 (48%) were available from at least one manufacturer approved by one of the seven non-US regulators, and two (5%) by four or more manufacturers. Across all drugs and regulators (including the FDA), 66 (39%) drugs were available from four or more total manufacturers. Of 109 drugs with at least one non-US regulator approved manufacturer, 12 (11%) were approved for patients with rare diseases and 29 (27%) were WHO designated essential medicines; only 12 (11%) were complex products that might be more complicated to import. The highest numbers of drugs were indicated for treating cardiovascular diseases, diabetes, or hyperlipidemia (19, 17%); psychiatric disease (16, 15%); and infectious diseases (15, 14%). In 2015, Medicaid alone spent nearly US$700m (£508m; €570m) on generic drugs without adequate US competition that could have had a manufacturer approved by non-US peer regulatory agencies. CONCLUSION In this study, more than half the off-patent drugs with no generic competition in the USA had at least one independent manufacturer approved by a non-US peer regulatory agency; slightly fewer than half had four or more total manufacturers. Facilitating US patient access to such manufacturers could help sustain affordable access to essential off-patent drugs.
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Affiliation(s)
- Ravi Gupta
- Department of Medicine, Johns Hopkins Hospital and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas J Bollyky
- Global Health, Economics, and Development, Council on Foreign Relations, Washington, DC, USA
| | - Matthew Cohen
- Global Health, Economics, and Development, Council on Foreign Relations, Washington, DC, USA
| | - Joseph S Ross
- Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - 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, MA 02120, USA
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Chen SI, Fox ER, Hall MK, Ross JS, Bucholz EM, Krumholz HM, Venkatesh AK. Despite Federal Legislation, Shortages Of Drugs Used In Acute Care Settings Remain Persistent And Prolonged. Health Aff (Millwood) 2018; 35:798-804. [PMID: 27140985 DOI: 10.1377/hlthaff.2015.1157] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Early evidence suggests that provisions of the Food and Drug Administration Safety and Innovation Act of 2012 are associated with reductions in the total number of new national drug shortages. However, drugs frequently used in acute unscheduled care such as the care delivered in emergency departments may be increasingly affected by shortages. Our estimates, based on reported national drug shortages from 2001 to 2014 collected by the University of Utah's Drug Information Service, show that although the number of new annual shortages has decreased since the act's passage, half of all drug shortages in the study period involved acute care drugs. Shortages affecting acute care drugs became increasingly frequent and prolonged compared with non-acute care drugs (median duration of 242 versus 173 days, respectively). These results suggest that the drug supply for many acutely and critically ill patients in the United States remains vulnerable despite federal efforts.
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Affiliation(s)
- Serene I Chen
- Serene I. Chen is an emergency medicine resident at Highland Hospital, in Oakland, California. She was a student at the Yale School of Medicine when this research was conducted
| | - Erin R Fox
- Erin R. Fox is director of the Drug Information Service at University of Utah Health Care, in Salt Lake City
| | - M Kennedy Hall
- M. Kennedy Hall is an acting instructor in the Division of Emergency Medicine at the University of Washington, in Seattle. He was a fellow in the Department of Emergency Medicine at the Yale School of Medicine when this research was conducted
| | - Joseph S Ross
- Joseph S. Ross is an associate professor in the Department of Internal Medicine at the Yale School of Medicine, in New Haven, Connecticut
| | - Emily M Bucholz
- Emily M. Bucholz is a resident physician at Boston Children's Hospital, in Massachusetts. She was a student at the Yale School of Medicine when this research was conducted
| | - Harlan M Krumholz
- Harlan M. Krumholz is the Harold H. Hines, Jr. Professor of Medicine and Epidemiology and Public Health at the Yale School of Medicine
| | - Arjun K Venkatesh
- Arjun K. Venkatesh is an assistant professor in the Department of Emergency Medicine at the Yale School of Medicine
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Dave CV, Hartzema A, Kesselheim AS. Prices of Generic Drugs Associated with Numbers of Manufacturers. N Engl J Med 2017; 377:2597-2598. [PMID: 29281576 DOI: 10.1056/nejmc1711899] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Alevizakos M, Detsis M, Grigoras CA, Machan JT, Mylonakis E. The Impact of Shortages on Medication Prices: Implications for Shortage Prevention. Drugs 2017; 76:1551-1558. [PMID: 27770351 DOI: 10.1007/s40265-016-0651-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Medication shortages are frequent and have clinical and financial ramifications; however, their effect on drug prices remains unknown. OBJECTIVE To examine price progression of medications affected by a shortage. METHODS We collected prices of medications covered under Medicare Part B, reflective of general market prices, and data on clinically relevant shortages for the period 2005-16. We used linear mixed-effects models to examine the price growth of affected medications. RESULTS Shortage medications demonstrated a quarterly price growth of -0.5 % (95 % confidence interval [CI] -1.6, 0.6) in the period preceding a shortage, 4.3 % (95 % CI 3.6, 4.5) during a shortage, and 4.1 % (95 % CI 2.6, 5.5) in the post-shortage period. Medications not affected by a shortage had a quarterly price growth of 0.2 % (95 % CI -0.3, 0.6). CONCLUSIONS Medication shortages are associated with price increases, and these increases are likely reactive to the low profitability of the affected medications and thus, proactive collaboration between the US Food and Drug Administration and industry can serve to identify low-profit drugs and evaluate measures to ensure continued production.
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Affiliation(s)
- Michail Alevizakos
- Infectious Diseases Division, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, POB, 3rd Floor, Suite 328/330, Providence, RI, 02903, USA
| | - Marios Detsis
- Infectious Diseases Division, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, POB, 3rd Floor, Suite 328/330, Providence, RI, 02903, USA
| | - Christos A Grigoras
- Infectious Diseases Division, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, POB, 3rd Floor, Suite 328/330, Providence, RI, 02903, USA
| | - Jason T Machan
- Biostatistics Core, Lifespan Hospital System and Departments of Orthopaedics and Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, POB, 3rd Floor, Suite 328/330, Providence, RI, 02903, USA.
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Mahendraratnam N, Dusetzina SB, Farley JF. Prescription Drug Utilization and Reimbursement Increased Following State Medicaid Expansion in 2014. J Manag Care Spec Pharm 2017; 23:355-363. [PMID: 28230452 PMCID: PMC10398028 DOI: 10.18553/jmcp.2017.23.3.355] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA) expanded health care and medication insurance coverage through Medicaid expansion in select states. Expansion has the potential to increase the availability of health services to patients, including prescription medications. However, limited studies have examined how expansion affected prescription drug utilization and reimbursement. OBJECTIVE To compare prescription drug utilization (number of prescriptions filled) and reimbursement trends between states that did and did not expand Medicaid coverage in 2014, while accounting for known effects of expansion on Medicaid enrollment. METHODS We conducted a comparative interrupted time series using retrospective Medicaid state drug utilization data from 2011 to 2014. After inclusion/exclusion criteria, 8 states that expanded Medicaid in 2014 and 10 states that did not expand Medicaid were studied. Primary outcomes were changes in quarterly prescription drug utilization and quarterly total prescription drug reimbursement before and after expansion. To account for increases in enrollment in expansion states, secondary outcomes were per-member-per-quarter (PMPQ) utilization and reimbursement before and after expansion. RESULTS Expansion states experienced a 1.4 million prescriptions per quarter and $163 million per quarter increase in utilization and reimbursement above the change in rates observed in nonexpansion states after expansion (P < 0.001). Specifically, 1 year after ACA implementation, expansion states used 17.0% more prescriptions and spent 36.1% more in reimbursement than the quarter preceding expansion. Expansion and nonexpansion states experienced significant drops in PMPQ prescriptions immediately after expansion (P < 0.001), but PMPQ prescriptions and reimbursement trends increased by the end of the postexpansion period in expansion states (P < 0.029 and P < 0.001, respectively). CONCLUSIONS Study results suggest that Medicaid expansion offers vulnerable patients who were previously uninsured increased access to health care resources, specifically prescription drugs. Although this hypothesis would benefit from further testing, it aligns with previous studies that have shown that Medicaid expansion has led to increased access to coverage and care. While enrollment contributes to the increase in prescription utilization and reimbursement, the drop in PMPQ utilization suggests that the patients entering the program are healthier than existing patients. This shows that risk pooling is working. However, the increase in PMPQ reimbursement suggests that new enrollment may not be the only factor driving reimbursement changes. Factors such as changes in product mix, risk pool composition, and drug pricing and their effects on total and per-member reimbursement should be evaluated in future studies. DISCLOSURES No outside funding supported this study. Mahendraratnam is currently a Worldwide Health Economics and Outcomes Research Pre-doctoral Fellow at Bristol-Myers Squibb and previously provided advisory services to public and private sector clients while employed at Avalere Health, an Inovalon Company, as well as completed an internship at Genentech, a member of the Roche Group. Farley and Dusetzina have no conflicts of interest to report. Preliminary results of this study were presented at the 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 21st Annual Meeting in Washington, DC, on May 21-25, 2016, and the 2016 AcademyHealth Annual Research Meeting (ARM) in Boston, Massachusetts, on June 26-28, 2016. Study concept and design were contributed by Farley, Mahendraratnam, and Dusetzina. Mahendraratnam, Farley, and Dusetzina collected the data, and data interpretation was performed by all the authors. The manuscript was written by Mahendraratnam, Farley, and Dusetzina and revised by Farley, Dusetzina, and Mahendraratnam.
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Lee CY, Chen X, Romanelli RJ, Segal JB. Forces influencing generic drug development in the United States: a narrative review. J Pharm Policy Pract 2016; 9:26. [PMID: 27688886 PMCID: PMC5034442 DOI: 10.1186/s40545-016-0079-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/10/2016] [Indexed: 11/17/2022] Open
Abstract
Background The United States (U.S.) Food and Drug Administration, as protectors of public health, encourages generic drug development and use so that patients can access affordable medications. The FDA, however, has limited mechanisms to encourage generic drug manufacturing. Main results Generic drug manufacturers make decisions regarding development of products based on expected profitability, influenced by market forces, features of the reference listed drug, and manufacturing capabilities, as well as regulatory restrictions. Barriers to the development of generic drugs include the challenge of demonstrating bioequivalence of some products, particularly those that are considered to be complex generics. Conclusions We present here a focused review describing the influences on generic manufacturers who are prioritizing drugs for generic development. We also review proposed strategies that regulators may use to incentivize generic drug development.
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Affiliation(s)
- Chia-Ying Lee
- Johns Hopkins University Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, 624 N. Broadway, Room 644, Baltimore, MD 21205 USA
| | - Xiaohan Chen
- Johns Hopkins University Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, 624 N. Broadway, Room 644, Baltimore, MD 21205 USA
| | | | - Jodi B Segal
- Johns Hopkins University Bloomberg School of Public Health, Center for Drug Safety and Effectiveness, 624 N. Broadway, Room 644, Baltimore, MD 21205 USA ; Division of General Internal Medicine, Johns Hopkins University School of Medicine, 624 N. Broadway, Room 644, Baltimore, MD 21205 USA
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15
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Hua LH, Cohen JA. Considerations in the development of generic disease therapies for multiple sclerosis. Neurol Clin Pract 2016; 6:369-376. [PMID: 27574572 DOI: 10.1212/cpj.0000000000000267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Medication prices are a major contributor to the high cost of care for multiple sclerosis (MS). The patents for some of the initial injectable therapies for relapsing MS recently expired, permitting development, regulatory approval, and marketing of generic alternatives with the potential for lower prices and cost savings to payers and patients. RECENT FINDINGS A generic version of glatiramer acetate 20 mg administered by daily subcutaneous injection recently received regulatory approval in the United States. Two additional generic versions of glatiramer acetate have been submitted for regulatory review. The development and testing of generic disease-modifying therapies for MS such as glatiramer acetate, which are complex molecules, present several complicating factors. SUMMARY This article provides background on the development of generics and reviews the status of generic glatiramer acetate.
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Affiliation(s)
- Le H Hua
- Lou Ruvo Center for Brain Health (LHH), Cleveland Clinic, Las Vegas, NV; and Mellen Center for Multiple Sclerosis Treatment and Research (JAC), Cleveland Clinic, Cleveland, OH
| | - Jeffrey A Cohen
- Lou Ruvo Center for Brain Health (LHH), Cleveland Clinic, Las Vegas, NV; and Mellen Center for Multiple Sclerosis Treatment and Research (JAC), Cleveland Clinic, Cleveland, OH
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16
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Schumock GT, Li EC, Suda KJ, Wiest MD, Stubbings J, Matusiak LM, Hunkler RJ, Vermeulen LC. National trends in prescription drug expenditures and projections for 2016. Am J Health Syst Pharm 2016; 73:1058-75. [PMID: 27170624 DOI: 10.2146/ajhp160205] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2016 in nonfederal hospitals, clinics, and overall (all sectors). METHODS Drug expenditure data through calendar year 2015 were obtained from the IMS Health National Sales Perspectives database and analyzed. Other factors that may influence drug spending in hospitals and clinics in 2016, including new drug approvals and patent expirations, were also reviewed. Expenditure projections for 2016 were based on a combination of quantitative analyses and expert opinion. RESULTS Total U.S. prescription sales in the 2015 calendar year were $419.4 billion, which was 11.7% higher than sales in 2014. Prescription expenditures in clinics and nonfederal hospitals totaled $56.7 billion (a 15.9% increase) and $33.6 billion (a 10.7% increase), respectively, in 2015. In nonfederal hospitals, growth in spending was driven primarily by increased prices for existing drugs. The hepatitis C combination drug ledipasvir-sofosbuvir was the top drug overall in terms of 2015 expenditures ($14.3 billion); in both clinics and nonfederal hospitals, infliximab was the top drug. Individual drugs with the greatest increases in expenditures in 2015 were specialty agents and older generics; these agents are likely to continue to influence total spending in 2016. CONCLUSION We project an 11-13% increase in total drug expenditures overall in 2016, with a 15-17% increase in clinic spending and a 10-12% increase in hospital spending. Health-system pharmacy leaders should carefully examine local drug utilization patterns in projecting their own organization's drug spending in 2016.
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Affiliation(s)
- Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL.
| | - Edward C Li
- Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME
| | - Katie J Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edwards Hines Jr. VA Hospital, Hines, ILDepartment of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Michelle D Wiest
- UC Health, Cincinnati, OHJames L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
| | - JoAnn Stubbings
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | | | | | - Lee C Vermeulen
- Center for Clinical Knowledge Management, UW Health, Madison, WISchool of Pharmacy, University of Wisconsin, Madison, WI
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