13 Nov Government Spending on Biologic Anti-Rheumatic Drugs Doubles Over 4 Years
MedicalResearch.com Interview with:
Dr. McCormick
Natalie McCormick, Ph.D.
Post-Doctoral Research Fellow
Clinical Epidemiology Program
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital
Department of Medicine, Harvard Medical School
Arthritis Research Canada
MedicalResearch.com: What is the background for this study?
Response: Biologic disease-modifying anti-rheumatic drugs (bDMARDs) have improved the health and productivity of many people living with moderate-to-severe inflammatory rheumatic diseases. They are also among the highest-spend drugs in the USA, with substantial out-of-pocket costs that pose barriers to treatment initiation and adherence. To understand the drivers of ongoing bDMARD spending growth, and effective ways of containing costs, we analysed drug spending data for all bDMARD claims in Medicare Part D, Part B fee-for-service, and Medicaid over 2012 to 2016, isolating the impact of changes in drug prices from changes in utilisation.
MedicalResearch.com: What are the main findings?
Response: Spending on Medicare and Medicaid claims for bDMARDs nearly doubled from $5.3 billion in 2012 to $10.3 billion in 2016. Majority of this five-year, $5.0 billion spending increase was from post-market drug price increases alone, rather than changes in treatment uptake or duration which could have added clinical value. Surprisingly, it was the earliest-approved drugs that had the biggest price increases. Time-varying manufacturers’ rebates had little impact on these findings.
MedicalResearch.com: What should readers take away from your report?
Response: Price hikes can impose considerable financial and disease burdens on bDMARD recipients, as these drugs are placed in specialty tiers where patients pay a percentage of the pre-rebate (list) price. Thus, even if rebates increase alongside list prices, patients do not benefit directly.
While proposals to remove rebates or pass them along to consumers may help some beneficiaries, more changes are needed to control public spending and patients’ out-of-pocket costs for these potent treatments. For example, eliminating specialty tiers altogether or allowing Medicare to negotiate with manufacturers directly.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We did not have access to individual-level data but would like to investigate how these price increases may impact patients’ out-of-pocket costs and adherence to therapy over the long term. With recipient numbers also driving spending growth, we’d like to see which diagnoses had the biggest increases in bDMARD uptake.
Moving forward, it will also be important to assess the impact of lower-priced DMARD biosimilars on public spending, though only two biosimilars are being marketed in the USA at this time.
MedicalResearch.com: Is there anything else you would like to add?
Response: This research is being presented in a Plenary session at the 2019 American College of Rheumatology annual meeting. The accompanying manuscript is published in Arthritis & Rheumatology: https://onlinelibrary.wiley.com/doi/10.1002/art.41138.
The authors are supported by training and salary awards from the Canadian Institutes of Health Research (NM), National Institutes of Health (ZSW, JH), Rheumatology Research Foundation (ZSW), and Caney Family Foundation (CAS). We no actual or potential conflicts of interest to disclose.
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Last Updated on November 13, 2019 by Marie Benz MD FAAD