Abstract 13439: Trends in Spending for P2Y12 Inhibitors by Medicare and Medicaid

Abstract

Introduction: Use of a P2Y12 inhibitor (P2Y12i) is standard of care for many conditions related to atherosclerotic cardiovascular disease. The more potent P2Y12is, prasugrel and ticagrelor, lead to improved outcomes in MI patients compared to clopidogrel. Generic prasugrel became available in 2017, while ticagrelor remains brand-name. The impact of generic P2Y12i availability on Medicare and Medicaid program spending is unknown. Methods: We evaluated P2Y12i total claims and inflation-adjusted spending in millions (M) of dollars using the 2015-2020 Medicare Part D and Medicaid prescription drug spending datasets. Total cost savings were estimated by switching from ticagrelor to generic prasugrel and clopidogrel. Results: From 2015 to 2020, total P2Y12i spending increased by Medicare (543M to 604M) and Medicaid (61M to 83M), although total claims decreased. In 2015, generic clopidogrel was the most prescribed P2Y12i within the Medicare program (94.2% of claims) and contributed the largest portion of total costs (45.0%). By 2020 ticagrelor contributed to most Medicare costs for P2Y12is (62.0%) despite constituting only 6.9% of claims (Figure). Generic prasugrel constituted 2.2% of Medicare P2Y12i claims in 2020 and contributed to 6.0% of total costs. Total 2020 Medicare savings by switching from ticagrelor to generic prasugrel or clopidogrel would have been 270M and 361M, respectively. In Medicaid, brand-name prasugrel had the largest contribution to costs in 2015 (48.1%) and ticagrelor constituted the most costs in 2020 (80.3% with 9.8% of claims). Total 2020 Medicaid savings by switching from ticagrelor to generic prasugrel or clopidogrel would have been 59.0M and 65.5M in 2020, respectively. Conclusions: Brand-name ticagrelor constitutes > 60% of total 2020 P2Y12i costs in Medicare and Medicaid, despite being used in < 10% of claims. Use of generic prasugrel remains low, despite its efficacy and potential to reduce prescription drug spending.