Drug Expenditures Research Articles

The usage of over-the-counter products by private insured patients in Germany \u2013 a claims data analysis with focus on complementary medicine

BackgroundAn important contribution to well-being of human beings can be observed by the use of self-medication products that is reflected in the constantly growing volume of over-the-counter (OTC) drugs. The aim of the current study was to extend the measurement concept for OTCs by exploring the relevance of the peripheral assortment provided by the widely accepted framework of the Anatomical Therapeutical and Chemical (ATC) classification of the WHO.MethodsThe focus was on the prescriptions and drug-related receipts submitted by privately insured persons to 18 private health insurers (PHIs) in Germany from the year 2016. The age- and gender-specific average claims amount per risks of outpatient drug expenditure were used as weights to scale up the relative distributions of the item amounts. The ATC-classification defines the commodity groups and discriminates between the main and the peripheral assortment. A descriptive analysis assessed the OTC frequencies and sum scores of the product groups within the main and peripheral assortment whereby the study group explored and assessed the relevance of each category independently according to the OTCs and integrative medicines.ResultsThe analysis included 22.1 Mio. packages from the main assortment and examined 10.1 Mio. packages from the peripheral assortment. The latter was examined thoroughly and the commodity groups “Pharmaceutical food products”, “Medicinal products for special therapy options” and particular “Hygiene and body care products” meet the defined requirements for OTCs relevant for integrative medicines. A high proportion of OTC products from the peripheral assortment was associated with the categories “medicinal products for special therapy options”. Homeopathy and anthroposophy present two special therapy options, which are relevant for the extended OTC measurement.ConclusionsThe analysis of OTC drugs is feasible when the main and the peripheral assortment is available and enable to integrate about 18% of all OTCs, which are neglected by the common ATC-based approach. The presented extended approach may help to identify potential users of OTCs or people in need of OTC use. In case of the highly disputed homeopathy and anthroposophy products, more research among interactions with prescriptions drugs (Rx), nutrition’s and other potentially harmful exposures is recommended.

ORPHAN DRUG REGULATION IN VARIOUS REGIONS OF THE WORLD

Orphan medications became a significant share of drug expenditures in every country. The high cost of therapy is caused by the low prevalence of diseases and the need to compensate the investment of producers in long-term development and registration procedures. The article highlights the main stages of the formation of legislation regulating the circulation of orphan medicines in the United States, covering state guarantees for the development of «orphan medicines», and imperfections of the existing system which influence the cost and availability of medicines. On the example of the EU, the author examines the unified approaches of EU countries to determining the orphan status of medicines, which is especially relevant in the context of convergence and harmonization of national legal systems regulating the circulation of medicines. The purpose of this article is to analyze various approaches to regulating orphan medicinal products in order to determine the most effective practices. The author identifies the main barriers in the provision of medicines to patients with orphan diseases in the Russian Federation, analyzes the main directions of the development of the drug supply system and outlines possible directions for expanding access to necessary treatment methods.

Prioritization of Medicine Importation by the Private Sector in Sudan: Evidence from a Data Analysis, 2012-2015

ObjectivesThe objective of this study is to analyze the annual medicines imported by private sector for the period between 2012 and 2015 with the help of priority system based on ABC-VEN matrix analysis and therapeutic category analysis. MethodsA retrospective cross-sectional study was conducted. The Always, Better, and Control (ABC) analysis based on drug expenditure and Vital, Essential, and Nonessential (VEN) analysis based on the criticality of the drugs was performed for annual importation in 2015. ResultsUsing ABC analysis, we found that 47 items (9.2%) accounted for 70% of the budget (class A), whereas a larger numbers of items (344; 67.2%) accounted for only 10% of the importation costs (class C). A moderate number of items (120; 23.5%) comprised 20% of the annual medicine importation value (class B). VEN analysis revealed that 89 items (17.4%) in the vital category constituted 41.6% of the importation value, whereas 349 (68.3%) grouped as essential constituted 45.1% of the value, and 73 (14.2%) of the items considered as nonessential medicines consumed only 13.3% of the total medicines imported in 2015. From the resultant ABC-VEN coupled matrix, three categories were created I, II and III. ConclusionIn view of limited resources, it is important that the existing resources should be utilized appropriately. This study identified a range of suggestions for better medication importation. The ABC and VEN analyses along with the therapeutic category analysis technique are convenient, systematic, and replicable methods and should be adopted for optimization and prioritization of resources.

A Prospective Drug Utilisation Study and Pharmacoeconomic Analysis in Paediatric Dentistry at a Tertiary Hospital

Introduction: Paediatric dentistry is the branch of dentistry dealing with children from birth to adolescence. Children tend to suffer from various dental conditions which can be primarily infective in nature and hence requires drugs that can be expensive. Drug utilisation data are needed for developing and monitoring policies because data on drug expenditure are not sufficient.
 Methods: This was a prospective cross-sectional study conducted in the Department of Pedodontics (paediatric dentistry) of a tertiary care teaching institute in Kathmandu, Nepal from July 2019 to December 2019. During the study period a total of 200 prescriptions were collected. Analysis was conducted using MS excel 2016 and further required analysis was done using Statistical Package for the Social Sciences v22.0.
 Results: A total of 200 prescriptions were analysed during the study period, of which 126 were males whereas 74 were females. The most common drug prescribed was paracetamol whereas amoxicillin was the most commonly prescribed antibiotics. Most common condition was periapical abscess but space infection was the most expensive condition.There was no statistically significance between the cost of drugs prescribed for the male and female patients.
 Conclusions: The drug prescription pattern was found to be rational. Every institution must have their own Drugs and Therapeutics Committee as has been suggested by WHO, so that patients will be benefited through decreasing economical burden, and adverse drug reactions and that by this, therapeutic effect will be increased.

Biosimilars in the French and Polish System: Chosen Aspects of Reimbursement and Access

The EU approved the first biosimilar drug in 2006. By 2017, the EU had authorized the highest number of biosimilars worldwide, acquiring considerable experience in their use and safety. In May 2019, the European Medicines Agency (EMA) search engine showed 54 authorized biosimilars. Biosimilars reduce public expenditure; however, the discussion about their potential disadvantages is still ongoing. Each country adopts different regulations on the interchangeability, switching, and substitution of a reference medicine by its biosimilar, since the EMA does not regulate this issue. Additionally, each nation has a unique reimbursement system, which results in significant differences in patients’ access to biosimilars. The importance of securing a higher availability of these cheaper versions of biological drugs is well-recognized. The better the access to these biosimilars is, the lower the overall drug expenditure and need for rationing would be, and therefore the better treatment results. The aim of this paper is to compare selected aspects of reimbursement and access to the EMA authorized biosimilar medicines in two countries – France and Poland. The stated drug policy goal of both countries is to significantly improve biosimilar implementation in the coming years. The research is based on an analysis of four main sources: the EMA biosimilars database, the Polish reimbursement list published by the Polish Ministry of Health, and two French reimbursement databases published by the French Ministry of Health. An additional literature review was conducted. The expected results concentrate on differences in the number of reimbursed biosimilars, the average time between EMA authorization and country reimbursement decision date, and the availability of biosimilars registered outside of the centralized (EMA) procedure. These findings could identify areas of improvement and help with discussions on how to optimize the reach of biosimilars, as well as improve French-Polish collaboration on this matter.

Prospects for development of group purchasing organizations (GPOs) in China within the context of national centralized drug procurement.

Healthcare group purchasing organizations (GPOs) are considered to play an integral role in the healthcare supply chain by keeping prices low and helping all members of the healthcare system achieve their objectives. China has been exploring GPOs in the field of drug procurement since 2015, and there are currently three GPO models in Shanghai, Shenzhen, and Guangzhou. Although the three models operate differently and they have each been examined, they have all achieved certain results and demonstrated the ability to control drug expenditures. In 2018, the National Healthcare Security Administration implemented a national centralized drug procurement policy, also known as the 4 + 7 procurement policy ("4+7 Policy"). This policy context has also led to changes in the strategy for development of GPOs in China. GPOs need to explore strategies that do not overlap with the scope of 4 + 7 procurement, and they need to develop dynamic and personalized procurement plans that are more in line with first-line clinical practices to have a synergistic effect in combination with the "4+7 Policy." In the future, GPOs will grow rapidly in China. The number of GPOs need to be increased to prevent monopolies, and GPOs need to expand their diversified value-added services to perform more tasks in terms of supply chain management and data analysis.

1157-P: Out-of-Pocket and Health Plan Spending on Diabetes Drugs, 2006-2018

The rising cost of managing diabetes is of major concern. To examine trends in expenditures on diabetes drugs, we used OptumLabs Data Warehouse to identify commercially insured and Medicare Advantage enrollees with type 2 diabetes who filled ≥1 diabetes drug between 2006 and 2018. In each year, we examined mean health plan and patient out of pocket (OOP) spending, stratified by health plan (commercial vs. Medicare Advantage), for generic vs. brand, and for insulin vs. non-insulin drugs. We assessed trends using logistic regression. All costs were adjusted to 2018 U.S. dollars. 1,592,663 unique type 2 diabetes patients were included (commercially-insured: 698,725, Medicare Advantage: 893,938). Total mean diabetes drug expenditures increased among all patients (Figure). Among commercially insured patients, OOP spending increased for brand drugs and insulin but decreased for generics (p for trends <0.001). Health plan spending also increased for brand drugs and insulin (p<0.001) but did not change for generics (p=0.32). Among Medicare Advantage enrollees, OOP spending for brand drugs and insulin did not change (p=0.69 and 0.41, respectively), but decreased for generics (p<0.001). Health plan spending increased for brand drugs and insulin (p<0.001) but decreased for generics (p=0.02). Health plan and OOP spending on diabetes drugs increased 2006-2018, particularly among commercially insured patients, those using brand drugs and insulin. Disclosure K.J. Lipska: None. R.G. McCoy: None. H. Van Houten: None. X. Yao: None. J. Ross: Research Support; Self; Centers for Medicare and Medicaid Services, Janssen Pharmaceuticals, Inc., U.S. Food and Drug Administration. A.E. Altan: None. N. Shah: None.

What happens to drug use and expenditure when cost sharing is completely removed? Evidence from a Canadian provincial public drug plan

ObjectivesThe role of cost-sharing for medicines is under active policy discussion, including in proposals for value-based insurance design. To inform this debate, we estimated the impact of completely removing cost-sharing on medication use and expenditure using a quasi-experimental approach. MethodsFair PharmaCare, British Columbia’s income-based public drug plan, includes a household out-of-pocket limit. Therefore, when one household member starts a long-term high-cost drug surpassing this maximum, cost-sharing is completely removed for other family members. We used an interrupted time series design to estimate monthly prescriptions and expenditures of other household members, 24 months before and after cost-sharing removal. ResultsWe studied 2191 household members newly free of cost-sharing requirements, most of whom had lower incomes. R emoving cost-sharing increased the level of drug expenditure and prescription numbers by 16 and 19%, respectively (i.e. $2659.43 (95%$1507.27–$3811.59, p < 0.001); 50.0 (95%CI 25.1–74.9, p < 0.001)) relative to prior expenditures and utilization without changing pre-existing trends. Much of this change was driven by 533 individuals initiating medication for the first time after cost-sharing removal. This initiation substantially increased average expenditure, especially for antiviral agents. ConclusionsCompletely removing cost-sharing, independent of health status, significantly increased medication use and expenditure particularly due to medicine initiation by new users. While costs may be preventing use, the appropriateness of additional use, especially among new users, is unclear.

US oncologists' perception of the efficacy, safety, and willingness to prescribe biosimilar cancer therapies.

e15213 Background: Biosimilars are the fastest-growing class of therapeutic products in the United States and can offer treatment options that can potentially lower healthcare-related costs in cancer care. It is essential to know if an oncologist will use such products. Therefore, we assessed the expected biosimilar prescribing behaviors of practicing oncologists for the originator products Avastin, Herceptin, Rituxan and Neulasta. Methods: We conducted an online cross-sectional survey of 75 hospital affiliated (46.7%) and community-based (53.3%) oncologists in July 2019 and used a Likert scale rating of “Never,” “Seldom,” “Sometimes,” “Often” and Always.” Descriptive statistics and percentages are reported; the Chi-square test was used for between-group comparisons. Results: The majority of oncologists (62.7%) worked in a for-profit practice, with 38.7% of primary practices offering exclusive in-office dispensing. Physicians currently reported prescribing branded drugs often or always 76% of the time. When asked to rate biosimilars by quality, safety and effectiveness, over 70% of providers perceived these four biosimilars to be the same or near equivalent to the branded drug. When asked to report their expected likelihood of prescribing a biosimilar in the future, 60% of providers believed they would often or always prescribe a biosimilar. There was no difference in the providers’ current biosimilar prescription pattern by type of insurance plan. Provided financial equivalence, oncologists reported being more likely to prescribe a biosimilar to new patients (85.3%) compared to existing patients (69.3%) (p = 0.019). The top 3 drivers of using biosimilar cancer therapies are the patient’s out of pocket cost, value of reimbursement and cost to the practice; 61%, 51% and 52%, respectively for fee-for-service reimbursement and 69%, 44% and 61%, respectively for value-based reimbursement. When asked why providers would not switch from buy-and bill to white-bagging, control of the drug (41.3%) and financial benefit to the providers’ practice (40%) were the top 2 reasons. Conclusions: Biosimilars are expected to reduce drug expenditures in cancer care. While providers in this study found biosimilars to be safe and effective, they reported being less likely to prescribe these drugs when there is a potential for their practice to lose money and control of the drug. Payment models for biosimilars in cancer care must support practice economics.

National trends in prescription drug expenditures and projections for 2020.

To report historical patterns of pharmaceutical expenditures, to identify factors that may influence future spending, and to predict growth in drug spending in 2020 in the United States, with a focus on the nonfederal hospital and clinic sectors. Historical patterns were assessed by examining data on drug purchases from manufacturers using the IQVIA National Sales Perspectives database. Factors that may influence drug spending in hospitals and clinics in 2020 were reviewed, including new drug approvals, patent expirations, and potential new policies or legislation. Focused analyses were conducted for specialty drugs, biosimilars, and diabetes medications. For nonfederal hospitals, clinics, and overall (all sectors), estimates of growth of pharmaceutical expenditures in 2020 were based on a combination of quantitative analyses and expert opinion. In 2019, overall US pharmaceutical expenditures grew 5.4% compared to 2018, for a total of $507.9 billion. This increase was driven to similar degrees by prices, utilization, and new drugs. Adalimumab was the top drug in US expenditures in 2019, followed by apixaban and insulin glargine. Drug expenditures were $36.9 billion (a 1.5% increase from 2018) and $90.3 billion (an 11.8% increase from 2018) in nonfederal hospitals and clinics, respectively. In clinics, growth was driven by new products and increased utilization, whereas in hospitals growth was driven by new products and price increases. Several new drugs that will likely influence spending are expected to be approved in 2020. Specialty and cancer drugs will continue to drive expenditures. For 2020 we expect overall prescription drug spending to rise by 4.0% to 6.0%, whereas in clinics and hospitals we anticipate increases of 9.0% to 11.0% and 2.0% to 4.0%, respectively, compared to 2019. These national estimates of future pharmaceutical expenditure growth may not be representative of any particular health system because of the myriad of local factors that influence actual spending.

Interventional Pharmacoeconomics: A Novel Mechanism for Unlocking Value.

Cancer care's sustainability is challenged by drug expenditures. In the absence of systemic change, innovation is needed to curtail drug costs. Interventional pharmacoeconomics (IVPE) utilizes clinical research to identify safe, efficacious, cost-conscious dosing regimens to extract maximum value from expensive therapies. Strategies include de-escalation of dosage, treatment duration and administration frequency, and substitution with therapeutic alternatives. In this review, we discuss how IVPE strategies have been successfully used and could be implemented going forward.

Forecasting drug utilization and expenditure: ten years of experience in Stockholm

BackgroundOperating under constrained budgets, payers and providers globally face challenges in enabling appropriate and sustainable access to new medicines. Among payer initiatives aiming to improve preparedness of healthcare systems for the introduction of new medicines, drug utilization and expenditure forecasting has played an increasingly important role. This study aims to describe the forecasting model used in Region Stockholm and to evaluate the accuracy of the forecasts produced over the past decade.MethodsIn this repeated cross-sectional study, we compared the predicted pharmaceutical expenditure with actual expenditure during the entire available follow-up period (2007–2018) both for overall drug utilization and for individual therapeutic groups. All analyses were based on pharmaceutical expenditure data that include medicines used in hospitals and dispensed prescription medicines for all residents of the region.ResultsAccording to the forecasts, the total pharmaceutical expenditure was estimated to increase between 2 and 8% annually. Our analyses showed that the accuracy of these forecasts varied over the years with a mean absolute error of 1.9 percentage points. Forecasts for the same year were more accurate than forecasts for the next year. The accuracy of forecasts also differed across the therapeutic areas. Factors influencing the accuracy of forecasting included the timing of the introduction of both new medicines and generics, the rate of uptake of new medicines, and sudden changes in reimbursement policies.ConclusionsBased on the analyses of all forecasting reports produced since the model was established in Stockholm in the late 2000s, we demonstrated that it is feasible to forecast pharmaceutical expenditure with a reasonable accuracy. A number of factors influencing the accuracy of forecasting were also identified. If forecasting is used to provide data for decisions on budget allocation and agreements between payers and providers, we advise to update the forecast as close as possible prior to the decision date.

PMH16 DRUG EXPENDITURE, PRICE, AND UTILIZATION IN THE U.S. MEDICAID PROGRAM: AN EMPIRICAL TREND ANALYSIS FOR SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) AND SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS) ANTIDEPRESSANTS FROM 1991 TO 2018

To assess the trends of drug expenditure, utilization and price of SSRIs and SNRIs antidepressants in the U.S. Medicaid program, and to highlight the market share of SSRI and SNRI and the effect of generic drug entry on Medicaid drug expenditure. A retrospective descriptive data analysis was conducted for this study. A national pharmacy summary data for study brand and generic drugs were retrieved from the Medicaid State Outpatient Drug Utilization Data collected by the U.S. Center of Medicaid/Medicare Services. The study covered the period between 1991 and 2018. Study drugs include 12 different SSRI and SNRI brands and their generics available in the market, such as Citalopram, Escitalopram, Paroxetine, Fluoxetine, Sertraline, Venlafaxine, Desvenlafaxine, Duloxetine, and Levomilnacipran. Data were analyzed annually and categorized by total prescriptions (utilization), total reimbursement (spending) and cost per prescription as the proxy of price for each drug. From 1991 to 2018, total prescription of SSRI and SNRI drugs rose by 3001%. Total Medicaid spending on SSRIs & SNRIs increased from $64.5 million to $2 billion in 2004, then decreased steadily until reached $755 million in 2018. SSRIs average utilization market share was 87% compared to 13% of SNRIs’ utilization market share. About 72% of total Medicaid spending on the two groups goes to SSRIs, remaining 28% for SNRIs. SSRI and SNRI brands’ prices increased overtime. On the contrary, generics price was steadily decreased overtime. SSRIs' and SNRIs' utilization increased dramatically over the last 30 years. The utilization shifted from brand to generic drugs resulting in less spending but high utilization due to their low generic drug price. SSRI generics captured most of the prescription market in Medicaid programs in the past 10 years. Generic substitution demonstrated to be a meaningful cost-containment policy for Medicaid programs.

PIN35 UTILIZATION, SPENDING AND PRICE TRENDS FOR ANTIVIRAL (FLU AGENTS) IN THE US MEDICAID PROGRAMS: EMPIRICAL DATA ANALYSIS FROM 1999-2018.

To examine trends in the utilization, pharmacy reimbursement, and prices of flu antiviral medications in the US Medicaid-covered population A retrospective drug utilization study was conducted using the national summary files for outpatient drug utilization and expenditure for flu anti-viral medications from the Centers for Medicare & Medicaid Services from January 2000 through June 2017, to examine the annual trends of the number of prescriptions, reimbursement expenditures, and the prices of flu antiviral medications. The study drugs included Oseltamivir phosphate (Tamiflu) and zanamivir (Relenza). The total number of prescriptions for flu anti-viral medications increased rapidly from 49,512 in 2000 to 1,134,353 in 2017. During the same period, the total pharmacy reimbursement for flu anti-viral medications in Medicaid increased from approximately $2.4 million in 2000 to approximately $244million in 2017. Tamiflu had a dominant market share with an average of 97.5% throughout the study period when compared to Relenza. The price per Tamiflu prescription drug increased over time, ranging from approximately $53 in 2000 to $213 in 2017, while Relenza increased from $42 to $63 in the same period. Medicaid expenditures and the number of prescriptions for flu anti-viral medications abruptly increased over the study period between 2000 and 2017. Increases in flu anti-viral drug expenditures from 2000 to 2017 were primarily due to the rising utilization of flu antiviral medications.

PRO52 EXPENDITURE, UTILIZATION, AND PRICE OF SPECIALTY DRUGS FOR MULTIPLE SCLEROSIS IN THE U.S MEDICAID POPULATION 2008 - 2018

Multiple sclerosis (MS) is a rare, long-standing, and disabling disease that affects the central nervous system and causes several clinical manifestations. As a result, this disease is associated with a high societal economic burden. To analyze the trends in drug expenditure, utilization, and cost of specialty drugs for the treatment of patients with MS in the US Medicaid program. In this retrospective drug utilization research analysis, we obtained prescription data and reimbursement of disease-modifying therapies for MS from the Centers for Medicare & Medicaid Services Medicaid State Drug Utilization Data between January 2008 and December 2018. The specialty drugs considered in our analysis included dimethyl fumarate, fingolimod, teriflunomide, cladribine, siponimod, alemtuzumab, natalizumab, ocrelizumab, daclizumab, glatiramer acetate, peginterferon beta-1a, interferon beta-1a, and interferon beta-1b. The annual trends of the number of prescriptions, reimbursement expenditures, and costs were calculated. The average reimbursement per prescription was calculated as an estimate of the drug cost. The annual MS drug utilization increased from 85,209 prescriptions in 2008 to 223,604 in 2016, and then decreased to 194,877 in 2018. The annual reimbursement surged by 633% in the 10-year study period between 2008 and 2018, from almost $172 million in 2008 to more than $1.4 billion in 2017, and then to approximately $1.26 billion in 2018. The cost per prescription increased over time for most MS brand-name drugs (eg, from $2033 in 2008 to $5114 in 2018 for natalizumab, and from $19,138 in 2016 to $23,588 in 2018 for alemtuzumab). In 2008, self-injectable drugs dominated the market. In recent years, a shift has occurred in the utilization and reimbursement of MS drugs, with oral medications becoming predominant. The study findings indicate intermarket and interbrand competition among the MS specialty drugs. The growing utilization and spending trends for specialty MS medications are significant and sizable in the US Medicaid programs. Medicaid cost-containment strategy is warranted to control the economic burden of state budgets across the country.

PMU109 COST EFFECTIVENESS OF MEDICATION THERAPY MANAGEMENT SERVICE IN HOSPITAL: A CASE STUDY IN A TERTIARY HOSPITAL IN SICHUAN, CHINA

To evaluate the effects of a Medication Therapy Management (MTM) service on the quality of therapy and cost in an elderly patient in a class A tertiary hospital in Sichuan, China. In this study, a self-contrast method was used to provide MTM service to a 74-year-old male patient with type 2 diabetes, hypertension, and palpitations. The pre-intervention survey and post-intervention survey after 3-month follow-up were used to evaluate the changes in the patient's symptoms and signs, laboratory tests, and compliance before and after MTM service. Cost-effectiveness analysis was used to evaluate the economic efficiency of MTM. This study considered only direct health care costs, including drug expenditures, transportation and MTM service costs. The follow-up results showed that the patient kept a high-quality life, a significantly reduced number of hypoglycemic events, and the palpitations were significantly relieved. Glycated hemoglobin (HbAlc) decreased from 7.8% to 6.5%, fasting blood glucose (FBG) decreased from 7-9mmol/L to 5.1-6.4mmol/L, and 2h postprandial blood glucose(2hPBG) decreased from 13-14mmol/L to 8.4-11mmol/L. Morisky Medication Adherence Scale(MMAS-8) score increased from 2.27 to 6.75, and the patient was definitely more adherent than before. The cost/effectiveness analysis (CEA) showed C/E is 343.92 before MTM, and after MTM C/E is 326.55, which proved MTM was more cost-effective. MTM service can play a positive role in the treatment and management of chronic disease in hospital and although the MTM service cost will add to patients, it is more cost-effectivess. The economic evaluation of Medication Therapy Management services with pharmacists paticipated can provide reference for the reform of pharmaceutical service charge in medical institutions in China.

PDG39 CHALLENGE OR OPPORTUNITY? THE EXPANSION OF DRUG VOLUME-BASED PROCUREMENT IN CHINA

Aiming to reduce generic drug expenditure, optimize Basic Medical Insurance fund and ensure drug quality, Chinese payer introduced volume-based procurement (VBP) policy in “4+7” pilot cities (4 municipal cities: Beijing, Shanghai, Tianjin, Chongqing and 7 cities: Guangzhou, Shenzhen, Shenyang, Dalian, Xi’an, Chengdu and Xia’men) in 2018. 25 molecules that have passed Generic Quality Consistency Evaluation (GQCE) were selected to participate in the first round VBP bidding process, of which winners are granted 70% of respective market shares (hospital channel) by offering lower prices. This research explored the result and impact, monitored the nationwide implementation in 2019 and predicted the future dynamics of the policy. Through secondary research, we’ve reviewed the price cuts and associated BMI funds saving of 25 molecules in the pilot cities, and conducted qualitative interviews with drug procurement officials, pharma and payers to evaluate the implementation of the policy. First round VBP has successfully achieved its objectives, bringing enormous impact to China’s pharmaceutical industry. Price cuts of the 25 molecules averaged 55%, and, given that the value of 25 drugs in “4+7” cities accounts for around 2% of hospital channel sales, save approximately 1 billion USD combined. Higher cost-effectiveness of generic drugs leaves more funds for the reimbursement of innovative drugs. The first round VBP has been successfully rolled out in 11 pilot cities. Challenges and problems incurred in VBP have been effectively addressed. The first round VBP will be rolling out nationwide from 2020. The government has already selected 33 molecules for second round VBP and the bid winners will be generated on Jan 17th, 2020. VBP policy preserves BMI funds, reduces patients’ economic burden, and leaves more funds for reimbursing innovative drugs. VBP’s rolling out nationwide will bring great opportunities to products that have passed GQCE.

Prescription drug expenditure trends and projections in the US

Prescription drug expenditure trends and projections in the US

PCV63 TRENDS IN CONVERSION TO GENERIC ATORVASTATIN AMONG MEDICARE BENEFICIARY STATIN USERS

Substituting brand-name medications with generic equivalents provides lower cost options for patients and can mitigate drug expenditures. Brand-name atorvastatin was the most frequently prescribed brand-name statin until generic was available in the United States on 11/30/2011. The objective of our study was to examine frequency and time to conversion to generic atorvastatin for patients who were on brand-name atorvastatin or other statins. We identified Medicare beneficiaries with any new statin prescriptions between 1/1/2007 and 11/30/2011 using the Chronic Conditions Data Warehouse 5% sample. Continuous enrollment in Medicare Parts A, B, and D for a minimum of 12 months prior to initial statin prescription and through 2012 was required. Users who switched statin type before, or did not refill after 11/30/2011, were excluded. Users were followed through 2015 or until censoring/death. We examined the proportion of statin users who switched to generic atorvastatin and the number of refills before switching. Of 43,307 statin users who met the eligibility criteria, 12,660 (29%) switched to generic atorvastatin after 11/30/2011 versus remaining on their current statin. 89% of brand-name atorvastatin users (n=5,420) switched within 1.8 refills on average, followed by 21% of both simvastatin (n=4,883) and brand-name rosuvastatin (n=863) users within 4.8 and 4.9 refills, respectively, and 15% of pravastatin users (n=1,058) within 4.5 refills. The availability of generic atorvastatin resulted in switching among the vast majority of brand-name atorvastatin users and among other statins but at a slower rate. The rapid rate of switching among Lipitor users was likely due to Medicare policy and pharmacies’ ability to substitute automatically to a generic without consulting a prescriber. Brand-name rosuvastatin’s lack of generic availability and simvastatin’s high-intensity dose restriction may have also contributed to switching. Future research should consider how these trends relate to statin expenditures and other effects such as adherence.

PND116 EXAMINE THE SPENDING AND UTILIZATION PATTERNS OF SECOND-GENERATION ANTIPSYCHOTICS BASED ON MEDICAID CLAIMS DATABASE

Antipsychotics have been a major driver of Medicaid prescription drug expenditure, mostly due to high cost and utilization of atypical antipsychotics. The study objective is to describe and evaluate the trends of atypical antipsychotics’ expenditure, utilization and price. A retrospective time-series trend analysis was conducted. The primary data source was the National Medicaid Pharmacy summary claim files collected by the Center for Medicaid/Medicare Services from 1991 to 2017. The quarterly reimbursement amount, number of prescriptions (Rx), reimbursement per prescription and per unit (proxy of drug price) figures were constructed for each branded and generic atypical antipsychotic such as olanzapine, risperidone, quetiapine, aripiprazole, and ziprasidone. The trends were compared between branded and generic drugs in order to assess the impact of generic entry. The annual percentage changes were calculated for reimbursement, utilization, and price.. Total Medicaid spending on atypical antipsychotics increased from $16 million in 1991 to $5.5 billion in 2005, averaged a 59% growth rate. The utilization also increased from 172 thousand Rx to over 21 million Rx in 2005. Post-2006 period saw a sharp decline in both uptake and spending, which bottomed out at $3.6 billion reimbursed and 10.7 million Rx dispensed in 2008, before slowly recovered. Despite the percentage of antipsychotics Rx dispensed as generics exploded from 12% in 2008 to 89% in 2017, the majority of expenditures were driven by branded medications, accounting for over 83%, driven by increased price per Rx. Use of generic drugs grew in marketshare, but low impact on the price of existing branded drugs. Outside of cost, providers and patients’ preferences, off-label usage, FDA warnings and lawsuits are all important factors impacted spending and utilization of this class of drugs.