Section of General Internal Medicine and the National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut 06510.
Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut 06510.
J Clin Endocrinol Metab. 2019 Jun 1;104(6):2305-2314. doi: 10.1210/jc.2018-02197.
Generic drugs account for 9 out of 10 prescriptions dispensed in the United States but for a lower proportion of commonly prescribed thyroid hormone replacement therapies.
Characterize temporal patterns of generic and brand-name thyroid hormone drug use, including patient and prescriber characteristics associated with brand-name use.
Cross-sectional longitudinal analysis of national data from a large administrative claims database from January 2007 through December 2016.
Adults with insurance coverage through commercial, Medicare Advantage, and Medicare Part D health plans.
Generic and brand-name thyroid hormone drug use.
From 2007 to 2016, the annual number of thyroid hormone treatment pharmacy fills increased from 8,905,836 in 2007 to 11,613,923 in 2016, 73.6% of which were for generic levothyroxine, 23.4% for brand-name levothyroxine, and the remaining for other formulations. Dispensing of generic thyroid hormone drugs increased from 59.8% in 2007 to 84.9% in 2016 and was consistently higher among Medicare Advantage and Medicare Part D when compared with the commercial beneficiary population. For all three beneficiary populations, use of brand-name products was less common among older adults and more common among women and those receiving prescriptions from endocrinologists and was more common among those of white race and with greater household income for the Medicare Advantage and commercial beneficiary populations (P < 0.001).
Brand-name thyroid hormone product use declined from 2007 to 2016 among three large, national insurer beneficiary populations. Although certain patient characteristics were associated with brand-name use, prescriber specialty was the strongest predictor.
在美国，通用药物占处方配药的十分之九，但在常用甲状腺激素替代疗法中所占比例较低。
描述通用药物和品牌药物甲状腺激素药物使用的时间模式，包括与品牌药物使用相关的患者和处方医生特征。
对来自大型行政索赔数据库的全国性数据进行的一项横断面纵向分析，时间范围为 2007 年 1 月至 2016 年 12 月。
通过商业、医疗保险优势和医疗保险 D 部分健康计划获得保险的成年人。
通用和品牌甲状腺激素药物的使用。
从 2007 年到 2016 年，甲状腺激素治疗药房配药量从 2007 年的 8905836 增加到 11613923，其中 73.6%为通用左甲状腺素，23.4%为品牌左甲状腺素，其余为其他配方。通用甲状腺激素药物的配药量从 2007 年的 59.8%增加到 2016 年的 84.9%，与商业受益人群相比，医疗保险优势和医疗保险 D 部分的配药量一直更高。对于所有三种受益人群，年龄较大的患者使用品牌产品的情况较少，女性和从内分泌医生处获得处方的患者使用品牌产品的情况更为常见，而在医疗保险优势和商业受益人群中，白人种族和家庭收入较高的患者使用品牌产品的情况更为常见（P < 0.001）。
在三个大型全国性保险公司受益人群中，品牌甲状腺激素产品的使用从 2007 年到 2016 年下降。尽管某些患者特征与品牌药物使用有关，但处方医生的专业是最强的预测因素。
