Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave, Cincinnati, OH 45267-0004, USA,
J Ment Health Policy Econ. 2021 Mar 1;24(1):3-11.
SSRIs and SNRIs are antidepressants that have largely substituted old antidepressants like Monoamine Oxidase Inhibitors (MAOIs) and Tricyclic Antidepressants (TCAs). They have been widely used since 1987 when the FDA approved the first SSRI Fluoxetine and the first SNRI Venlafaxine in 1993. Since then, several new SSRIs and SNRIs have been approved and entered the market. Utilization, pricing, and spending trends of SSRIs and SNRIs have not been analyzed yet in Medicaid.
To assess the trends of drug expenditure, utilization, and price of SSRI and SNRI antidepressants in the US Medicaid program, and to highlight the market share of SSRIs and SNRIs and the effect of generic drug entry on Medicaid drug expenditure.
A retrospective descriptive data analysis was conducted for this study. National pharmacy summary data for study brand and generic drugs were retrieved from the Medicaid State Outpatient Drug Utilization Data. These data were collected by the US Centers for Medicare and Medicaid Services (CMS). The study period was 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 the price for each drug.
From 1991 to 2018, total prescriptions of SSRI and SNRI drugs rose by 3001%. Total Medicaid spending on SSRIs and SNRIs increased from USD 64.5 million to USD 2 billion in 2004, then decreased steadily until it reached USD 755 million in 2018. The SSRIs average utilization market share was 87% compared to 13% of the SNRIs utilization market share. About 72% of total Medicaid spending on the two groups goes to SSRIs, while the remaining 28% goes to SNRIs. Brand SSRIs and SNRIs prices increased over time. On the contrary, generic drugs prices steadily decreased over time.
An increase in utilization and spending for both SSRI and SNRI drugs was observed. After each generic drug entered the market, utilization shifted from the brand name to the respective generic due to their lower price. These generic substitutions demonstrate a meaningful cost-containment policy for Medicaid programs.
Our findings show the overall view of Medicaid expenditure on one of the most commonly prescribed drug classes in the US. They also provide an important insight toward the antidepressant market and the importance of monitoring different drugs and their alternatives.
SSRIs 和 SNRIs 是抗抑郁药，它们在很大程度上取代了单胺氧化酶抑制剂 (MAOIs) 和三环抗抑郁药 (TCAs) 等旧的抗抑郁药。自 1987 年 FDA 批准首个 SSRI 氟西汀和首个 SNRI 文拉法辛以来，它们已被广泛使用。此后，又有几种新的 SSRIs 和 SNRIs 获得批准并进入市场。SSRIs 和 SNRIs 的利用、定价和支出趋势尚未在医疗补助计划中进行分析。
评估 SSRI 和 SNRI 类抗抑郁药在美国医疗补助计划中的药物支出、利用和价格趋势，并强调 SSRI 和 SNRIs 的市场份额以及仿制药进入对医疗补助药物支出的影响。
本研究进行了回顾性描述性数据分析。从医疗补助州门诊药物利用数据中检索了研究品牌和仿制药的国家药房汇总数据。这些数据由美国医疗保险和医疗补助服务中心 (CMS) 收集。研究期间为 1991 年至 2018 年。研究药物包括市场上可获得的 12 种不同的 SSRI 和 SNRI 品牌及其仿制药，如西酞普兰、艾司西酞普兰、帕罗西汀、氟西汀、舍曲林、文拉法辛、去甲文拉法辛、度洛西汀和左米那普仑。数据每年进行分析，并按总处方（利用）、总报销（支出）和每处方成本（作为价格的代理）进行分类。
从 1991 年到 2018 年，SSRI 和 SNRI 药物的总处方量增长了 3001%。SSRIs 和 SNRIs 的医疗补助总支出从 1991 年的 6450 万美元增加到 2004 年的 20 亿美元，然后稳步下降，直到 2018 年达到 7.55 亿美元。SSRI 的平均利用市场份额为 87%，而 SNRI 的利用市场份额为 13%。两组中约 72%的医疗补助总支出用于 SSRIs，而其余 28%用于 SNRIs。品牌 SSRI 和 SNRIs 的价格随着时间的推移而上涨。相反，仿制药的价格随着时间的推移而稳步下降。
观察到 SSRI 和 SNRI 药物的利用和支出均有所增加。在每种仿制药进入市场后，由于价格较低，利用从品牌名转移到各自的仿制药。这些仿制药替代表明医疗补助计划采取了有意义的成本控制政策。
我们的研究结果提供了美国最常开处方的药物类别之一的医疗补助支出的全貌。它们还为抗抑郁药市场提供了重要的见解，并强调了监测不同药物及其替代品的重要性。
