Secular Trends in the Cost of Immunosuppressants after Solid Organ Transplantation in the United States.
Adolescent
Adult
Aged
Cost Savings
Cost-Benefit Analysis
Drug Costs
/ trends
Drug Utilization
/ economics
Drugs, Generic
/ economics
Female
Health Expenditures
/ trends
Humans
Immunosuppressive Agents
/ economics
Insurance, Health, Reimbursement
/ economics
Male
Medicare Part D
/ economics
Middle Aged
Organ Transplantation
/ economics
Registries
Time Factors
United States
Young Adult
Cost Savings
Drugs, Generic
Health Expenditures
Heart Transplantation
Immunosuppressive Agents
Insurance Carriers
Linear Models
Medicare Part D
Mycophenolic Acid
Prescription Drugs
Transplant Recipients
end-stage renal disease
heart disease
liver failure
tacrolimus
transplantation, kidney
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
07 03 2019
07 03 2019
Historique:
received:
04
09
2018
accepted:
16
01
2019
pmc-release:
07
03
2020
pubmed:
2
3
2019
medline:
1
4
2020
entrez:
2
3
2019
Statut:
ppublish
Résumé
Immunosuppressive medications are critical for maintenance of graft function in transplant recipients but can represent a substantial financial burden to patients and their insurance carriers. To determine whether availability of generic immunosuppressive medications starting in 2009 may have alleviated some of that burden, we used Medicare Part D prescription drug events between 2008 and 2013 to estimate the average annualized per-patient payments made by patients and Medicare in a large national sample of kidney, liver, and heart transplant recipients. Repeated measures linear regression was used to determine changes in payments over the study period. Medicare Part D payments for two commonly used immunosuppressive medications, tacrolimus and mycophenolic acid (including mycophenolate mofetil and mycophenolate sodium), decreased overall by 48%-67% across organs and drugs from 2008 to 2013, reflecting decreasing payments for brand and generic tacrolimus (21%-54%), and generic mycophenolate (72%-74%). Low-income subsidy payments, which are additional payments made under Medicare Part D, also decreased during the study period. Out-of-pocket payments by patients who did not receive the low-income subsidy decreased by more than those who did receive the low-income subsidy (63%-79% versus 24%-44%). The decline in payments by Medicare Part D and by transplant recipients for tacrolimus and mycophenolate between 2008 and 2013 suggests that the introduction of generic immunosuppressants during this period has resulted in substantial cost savings to Medicare and to patients, largely reflecting the transition from brand to generic products.
Sections du résumé
BACKGROUND AND OBJECTIVES
Immunosuppressive medications are critical for maintenance of graft function in transplant recipients but can represent a substantial financial burden to patients and their insurance carriers.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
To determine whether availability of generic immunosuppressive medications starting in 2009 may have alleviated some of that burden, we used Medicare Part D prescription drug events between 2008 and 2013 to estimate the average annualized per-patient payments made by patients and Medicare in a large national sample of kidney, liver, and heart transplant recipients. Repeated measures linear regression was used to determine changes in payments over the study period.
RESULTS
Medicare Part D payments for two commonly used immunosuppressive medications, tacrolimus and mycophenolic acid (including mycophenolate mofetil and mycophenolate sodium), decreased overall by 48%-67% across organs and drugs from 2008 to 2013, reflecting decreasing payments for brand and generic tacrolimus (21%-54%), and generic mycophenolate (72%-74%). Low-income subsidy payments, which are additional payments made under Medicare Part D, also decreased during the study period. Out-of-pocket payments by patients who did not receive the low-income subsidy decreased by more than those who did receive the low-income subsidy (63%-79% versus 24%-44%).
CONCLUSIONS
The decline in payments by Medicare Part D and by transplant recipients for tacrolimus and mycophenolate between 2008 and 2013 suggests that the introduction of generic immunosuppressants during this period has resulted in substantial cost savings to Medicare and to patients, largely reflecting the transition from brand to generic products.
Identifiants
pubmed: 30819667
pii: 01277230-201903000-00015
doi: 10.2215/CJN.10590918
pmc: PMC6419280
doi:
Substances chimiques
Drugs, Generic
0
Immunosuppressive Agents
0
Types de publication
Journal Article
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
421-430Subventions
Organisme : FDA HHS
ID : U01 FD005274
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 by the American Society of Nephrology.
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