Medicare and medicaid spending trends for immunomodulators prescribed for dermatologic conditions.

Immunomodulators are the most expensive prescription medications used in dermatology for chronic skin conditions. Each year, rising costs for immunomodulators pose significant financial burdens on patients and the healthcare system as a whole. Using the Centers for Medicare and Medicaid Services (CMS) we collected Medicare Part D (Medicare-D) and Medicaid spending data for immunomodulators with dermatologic indications or off-label use from 2012-2018. The average annual spending and average annual spending per dosage unit (AASPDU) was calculated for each of the thirteen included medications. Combined Medicare-D and Medicaid spending increased 319.9% from $2.5B in 2012 to $10.6B in 2018, with an average of $6.2B spent annually. For both Medicare-D and Medicaid, adalimumab ($1.8B, $968.8 m), etanercept ($1.4B, $467.5 m), and ustekinumab ($258.8 m, $131.0 m) had the highest overall annual spending. Additionally, ustekinumab ($16,825, $15,576), guselkumab ($10,132, $9,543), and ixekizumab ($4,895, $4,673) had the highest AASPDU for both Medicare-D and Medicaid. Medicare-D and Medicaid spending for immunomodulators has grown substantially (319.9%) from 2012-2018 and is likely to continue to rise. Given this increase in federal spending and continued emergence of new immunomodulators, it is important to learn how we can counteract the trends and reduce future expenses for patients and our healthcare system.