Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas.
Department of Pediatrics, Stanford University, Palo Alto, California.
JAMA Netw Open. 2020 Feb 5;3(2):e200181. doi: 10.1001/jamanetworkopen.2020.0181.
The United States spends more money on medications than any other country. Most extended-release drugs have not consistently shown therapeutic or adherence superiority, and switching these medications to less expensive, generic, immediate-release formulations may offer an opportunity to reduce health care spending.
To evaluate Medicare Part D and Medicaid spending on extended-release drug formulations and the potential savings associated with switching to generic immediate-release formulations.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used the 2012 to 2017 Medicare Part D Drug Event and Medicaid Spending and Utilization data sets to analyze 20 extended-release drugs with 37 Medicare formulations and 36 Medicaid formulations. Only cardiovascular, diabetes, neurologic, and psychiatric extended-release drugs saving at most 1 additional daily dose compared with their immediate-release counterparts were included. Extended-release drugs with therapeutic superiority were excluded. Analyses were conducted from January to December 2019.
Estimated Medicare Part D and Medicaid savings from switching extended-release to immediate-release drug formulations between 2012 and 2017.
Of the 6252 drugs screened for eligibility from the 2017 Medicaid Drug Utilization database and the 2017 Medicare Part D database, 67 drugs with extended-release formulations that were identified in the Medicare data set (20 distinct drugs with 37 formulations [19 brand, 18 generic]) were included in the analysis. In 2017, Medicare Part D spent $2.2 billion and Medicaid spent $952 million (a combined $3.1 billion) on 20 extended-release drugs. Between 2012 and 2017, Medicare Part D and Medicaid spent $12 billion and $5.9 billion, respectively, on extended-release formulations. Switching from brand-name to generic extended-release formulations was estimated to be associated with a $247 million reduction in Medicare spending and $299 million reduction in Medicaid spending in 2017, whereas switching all brand-name and generic extended-release formulations to immediate-release formulations in both Medicare and Medicaid was estimated to reduce spending by $2.6 billion ($1.8 billion for Medicare and $836 million for Medicaid) in 2017. During the study period, the estimated spending reduction associated with switching all patients receiving extended-release formulations (brand name extended-release and generic extended-release) to generic immediate-release formulations was $13.7 billion ($8.5 billion from Medicare and $5.2 billion from Medicaid).
The findings suggest that switching from extended-release drug formulations to therapeutically equivalent immediate-release formulations when available represents a potential option to reduce Medicare and Medicaid spending.
美国在药物上的支出比任何其他国家都多。大多数缓释药物并未始终显示出治疗或依从性优势，将这些药物转换为更便宜的、通用的、速释制剂可能是降低医疗保健支出的机会。
评估医疗保险 D 部分和医疗补助计划对缓释药物制剂的支出，以及转换为更便宜的通用速释制剂所带来的潜在节省。
设计、设置和参与者：这项横断面研究使用了 2012 年至 2017 年医疗保险 D 部分药物事件和医疗补助支出和利用数据集，分析了 20 种具有 37 种医疗保险配方和 36 种医疗补助配方的缓释药物。仅包括与速释制剂相比，最多可节省 1 个额外日剂量的心血管、糖尿病、神经病和精神科缓释药物。排除具有治疗优势的缓释药物。分析于 2019 年 1 月至 12 月进行。
2012 年至 2017 年间，从缓释制剂转换为速释制剂的医疗保险 D 部分和医疗补助计划节省的估计数。
在从 2017 年医疗补助药物利用数据库和 2017 年医疗保险 D 部分数据库筛选的 6252 种药物中，在医疗保险数据集中确定的具有缓释制剂的 67 种药物（具有 37 种配方[19 种品牌，18 种通用]的 20 种不同药物）被纳入分析。2017 年，医疗保险 D 部分在 20 种缓释药物上花费了 22 亿美元，医疗补助计划花费了 9.52 亿美元（总计 31 亿美元）。在 2012 年至 2017 年期间，医疗保险 D 部分和医疗补助计划分别在缓释制剂上花费了 120 亿美元和 59 亿美元。估计从品牌名缓释制剂转换为通用缓释制剂，2017 年医疗保险支出将减少 2.47 亿美元，医疗补助支出将减少 2.99 亿美元，而在医疗保险和医疗补助计划中，所有品牌名和通用缓释制剂均转换为速释制剂，估计 2017 年支出将减少 26 亿美元（医疗保险 180 亿美元，医疗补助 8.36 亿美元）。在研究期间，估计将所有接受缓释制剂（品牌名缓释制剂和通用缓释制剂）治疗的患者转换为通用速释制剂，将节省 137 亿美元（医疗保险 85 亿美元，医疗补助 52 亿美元）。
研究结果表明，在有治疗等效的速释制剂时，从缓释药物制剂转换可能是降低医疗保险和医疗补助支出的一种潜在选择。
