Estimated changes in price discounts for tenofovir-inclusive HIV treatments following introduction of tenofovir alafenamide

Dickson, Sean; Gabriel, Nico; Hernandez, Inmaculada

doi:10.1097/qad.0000000000003401

Cited by 8 publications

(25 citation statements)

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“…However, because the rebate cap was triggered for most years in the sample for most drugs, the impact of this limitation was likely minimal. Fourth, due to the unavailability of Medicaid and commercial insurance claims, we used Medicare claims to estimate the proportion of units that were eligible for 340B discounts, as was previously done . We then extrapolated this proportion of units eligible for 340B discounts to the Medicaid and commercial insurance markets.…”

Section: Discussionmentioning

confidence: 99%

“…This first iteration of the algorithm 5 assumed that the commercial discount set best price. For observations and years when the commercial discount was less than 23.1% of the list price (rendering this assumption false), we used a second iteration of the algorithm 5 to estimate the Medicaid base rebate as 23.1% of list price.…”

Section: Decomposition Of the Gross-to-net Bubble Into Discount Typesmentioning

confidence: 99%

“…We applied a newly published algorithm to decompose the overall gross-to-net bubble of leading insulin products into discount types . To our knowledge, this is the first study to decompose the overall gross-to-net bubble of these products.…”

Section: Introductionmentioning

confidence: 99%

“…To our knowledge, this is the first study to decompose the overall gross-to-net bubble of these products. The algorithm accounted for the association between commercial discounts and mandatory discounts under the best-price provision, which requires drug manufacturers to provide the greatest available commercial discount to the Medicaid and 340B programs . The algorithm also considered the Medicaid rebate cap, which limits total Medicaid and 340B discounts to the mean price of the drug.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Commercial and Mandatory Discounts in the Gross-to-Net Bubble for the Top Insulin Products From 2012 to 2019

et al. 2023

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ImportanceInsulin list prices have grown substantially since 2010, but net prices have declined since 2015 because of manufacturer discounts, leading to an increasingly large difference between list and net prices of drugs often called the gross-to-net bubble. It remains unclear to what extent the gross-to-net bubble represents voluntary manufacturer discounts negotiated in commercial and Medicare Part D markets (hereafter called commercial discounts) vs mandatory discounts under the Medicare Part D coverage gap, Medicaid, and the 340B program.ObjectiveTo decompose the overall gross-to-net bubble of leading insulin products into discount types.Design, Setting, and ParticipantsThis economic evaluation obtained data from Medicare and Medicaid claims and spending dashboards, Medicare Part D Prescriber Public Use File, and SSR Health for the top 4 commonly used insulin products: Lantus, Levemir, Humalog, and Novolog. The gross-to-net bubble, which represents total discounts, was estimated for each insulin product and year (from 2012 to 2019). Analyses were conducted in June to December 2022.Main Outcomes and MeasuresThe gross-to-net bubble was decomposed into 4 discount types: (1) Medicare Part D coverage gap discounts, (2) Medicaid discounts, (3) 340B discounts, and (4) commercial discounts. Coverage gap discounts were estimated using Medicare Part D claims data. Medicaid and 340B discounts were estimated using a novel algorithm that accounted for best prices set by commercial discounts.ResultsTotal discounts for the 4 insulin products increased from $4.9 billion to $22.0 billion. Commercial discounts represented a majority of all discounts, increasing from 71.7% of the gross-to-net bubble in 2012 ($3.5 billion) to 74.3% ($16.4 billion) in 2019. Among mandatory discounts, coverage gap discounts remained relatively consistent as a proportion of discounts (5.4% in 2012 vs 5.3% in 2019). Medicaid rebates decreased as a proportion of total discounts, from 19.7% in 2012 to 10.6% in 2019. The 340B discounts increased as a proportion of total discounts from 3.3% in 2012 to 9.8% in 2019. Results for the contribution of discount types to the gross-to-net bubble were consistent across insulin products.Conclusions and RelevanceResults of a decomposition of the gross-to-net bubble for leading insulin products suggest that commercial discounts play a growing role in lowering net sales compared with mandatory discounts.

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Section: Discussionmentioning

confidence: 99%

Section: Decomposition Of the Gross-to-net Bubble Into Discount Typesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of Commercial and Mandatory Discounts in the Gross-to-Net Bubble for the Top Insulin Products From 2012 to 2019

et al. 2023

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“…18 To overcome the limitations of previous estimates of net prices, we applied a recently developed method for estimating commercial discounts. 19 We estimated changes in insulin net prices faced by payers from January 1, 2012, to December 31, 2019, noting the introduction of new insulin products from 2015 to 2017.…”

Section: Introductionmentioning

confidence: 99%

Estimated Changes in Insulin Prices and Discounts After Entry of New Insulin Products, 2012-2019

et al. 2023

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ImportanceDespite the political salience of insulin prices, no study to date has quantified trends in insulin prices that account for manufacturer discounts (net prices).ObjectiveTo describe trends in insulin list prices and net prices faced by payers from 2012 to 2019 and estimate changes in net prices after the 2015 to 2017 entry of new insulin products.Design, Setting, and ParticipantsThis longitudinal study included an analysis of Medicare, Medicaid, and SSR Health drug pricing data from January 1, 2012, to December 31, 2019. Data analyses were performed from June 1, 2022, to October 31, 2022.ExposuresUS sales of insulin products.Main Outcomes and MeasuresNet prices faced by payers were estimated for insulin products as list prices minus manufacturer discounts negotiated in commercial and Medicare Part D markets (ie, commercial discounts). Trends in net prices were evaluated before and after the entry of new insulin products.ResultsNet prices of long-acting insulin products increased at an annual rate of 23.6% from 2012 to 2014 but decreased at an annual rate of 8.3% after the introduction of insulin glargine (Toujeo and Basaglar) and degludec (Tresiba) in 2015. Net prices of short-acting insulin increased at an annual rate of 5.6% from 2012 to 2017 but then decreased from 2018 to 2019 after the introduction of insulin aspart (Fiasp) and lispro (Admelog). For human insulin products, which did not experience entry of new products, net prices increased at an annual rate of 9.2% from 2012 to 2019. From 2012 to 2019, commercial discounts increased from 22.7% to 64.8% for long-acting insulin products, from 37.9% to 66.1% for short-acting insulin products, and from 54.9% to 63.1% for human insulin products.Conclusions and RelevanceIn this longitudinal study of US insulin products, results suggest that insulin prices substantially increased from 2012 to 2015, even after accounting for discounts. The introduction of new insulin products was followed by substantial discounting practices that lowered net prices faced by payers.

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Trends in Proportion of Medicare Part D Claims Subject to 340B Discounts, 2013-2020

Dickson,

Gabriel,

Hernandez

2023

JAMA Health Forum

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ImportanceDespite controversy surrounding the 340B program, no study has analyzed trends in the proportion of Medicare Part D pharmacy claims eligible for 340B discounts.ObjectiveTo describe trends in the proportion of Medicare Part D claims that are prescribed by 340B-affiliated clinicians and filled in 340B pharmacies.Design and SettingThis longitudinal, retrospective cohort study included 2013 to 2020 claims data from a 5% random sample of Medicare Part D beneficiaries from the Centers for Medicare &amp; Medicaid Services and 6292 nine-digit national drug codes that were used by at least 1000 Part D beneficiaries in a given year. Data analysis was completed from November 2022 to April 2023.Main Outcomes and MeasuresFor each drug and year, there were 3 outcomes: (1) proportion of total Part D claims that were prescribed by a 340B-affiliated clinician; (2) proportion of claims prescribed by a 340B-affiliated clinician that were filled in a 340B pharmacy; and (3) proportion of total Part D claims under the 340B program (ie, prescribed by a 340B-affiliated clinician and filled in a 340B pharmacy).ResultsThe proportion of prescriptions written by a 340B-affiliated clinician doubled from 9.4% in 2013 to 19.3% in 2020. The capture of 340B prescriptions by 340B pharmacies, defined as the proportion of claims prescribed by 340B-affiliated clinicians that were filled by 340B pharmacies, increased from 18.4% in 2013 to 49.9% in 2020. As a result, the total proportion of 340B claims in Part D increased from 1.7% in 2013 to 9.6% in 2020. Rates of 340B prescribing and capture increased consistently across therapeutic classes. In 2020, the antiviral therapeutic class was the class with the largest proportion of 340B claims (16.1%), followed by targeted antineoplastics (15.7%).Conclusions and RelevanceThis cohort study demonstrated that from 2013 to 2020, the share of Medicare Part D claims prescribed by a 340B-affiliated clinician increased; however, the rate at which 340B-eligible prescriptions were filled at 340B pharmacies increased at a faster rate, driving the overall increase in 340B claims. Despite these trends, only half of 340B-eligible prescriptions were subject to the 340B discount in 2020.

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Estimated changes in price discounts for tenofovir-inclusive HIV treatments following introduction of tenofovir alafenamide

Cited by 8 publications

References 4 publications

Assessment of Commercial and Mandatory Discounts in the Gross-to-Net Bubble for the Top Insulin Products From 2012 to 2019

Assessment of Commercial and Mandatory Discounts in the Gross-to-Net Bubble for the Top Insulin Products From 2012 to 2019

Estimated Changes in Insulin Prices and Discounts After Entry of New Insulin Products, 2012-2019

Trends in Proportion of Medicare Part D Claims Subject to 340B Discounts, 2013-2020

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