Medicare Spending on Brand-name Combination Medications vs Their Generic Constituents

Abstract

IMPORTANCE Brand-name combination drugs can be more expensive than the sum of their components, especially when the constituent products are available as generic medications. The potential savings that could be achieved using generic components is not known.OBJECTIVE To estimate the additional cost to Medicare of prescribing brand-name combination medications instead of generic constituents. DESIGN, SETTING, AND PARTICIPANTSRetrospective analysis for 2011 through 2016 using the Medicare data set of Part D beneficiaries prescribed any of the 1500 medications that accounted for the highest total spending in 2015. Brand-name combination drugs that had identical or therapeutically equivalent generic constituents were included.EXPOSURES Brand-name, oral combination medications with constituents available either as generic drugs or therapeutically equivalent generic substitutes. MAIN OUTCOMES AND MEASURESThe estimated difference between the amount spent by Medicare on brand-name combination drugs and the estimated amount that would have been spent on substitutable generic components.RESULTS Among the 1500 medications evaluated, 29 brand-name combination medications were separated into 3 mutually exclusive categories: constituents available as generic medications at identical doses (n = 20), generic constituents at different doses (n = 3), and therapeutically equivalent generic substitutes (n = 6). For the constituents available as generic medications at identical doses category, total spending by Medicare in 2016 on the brand-name combination products was $303 million and the estimated spending for the generic constituents would have been $68 million, which is an estimated difference of $235 million. For the generic constituents at different doses category, total spending by Medicare in 2016 on the brand-name combination products was $232 million and the estimated spending for the generic constituents would have been $13 million, which is an estimated difference of $219 million. For the therapeutically equivalent generic substitutes category, total spending by Medicare in 2016 on the brand-name combination products was $491 million and the estimated spending for the generic constituents would have been $20 million, which is an estimated difference of $471 million. In 2016, the estimated spending for the generic constituents for these 29 drugs would have been $925 million less than the estimated spending for the brand-name combinations. For the 10 most costly combination products available during the entire study period, the listed Medicare spending could have been an estimated $2.7 billion lower between 2011 and 2016 if the generic constituents had been prescribed. CONCLUSIONS AND RELEVANCEIn 2016, the difference between the amount that the Medicare drug benefit program reported spending on brand-name combination medications and the estimated spending for generic constituents for the same number of doses was $925 million. Promoting generic substitution and therapeutic interchange through prescriber education and more ...

Treatment patterns of antihypertensive fixed‐dose combinations according to age and number of agents prescribed: Retrospective analysis using a Japanese claims database

“…In a retrospective study carried out in the USA, investigating Medicare spending on brand-name combination medications vs their generic constituents, it was found that medical expenses were higher for brand-name combinations compared with generic constituents. 16 A similar study in Japan would be required to confirm whether the findings are applicable. Another disadvantage to FDC is the fact that the agents are taken simultaneously, which means that chronotherapy with a particular agent cannot be used.…”

“…As well as not being able to make dose adjustments when using FDC, another disadvantage might be cost when compared with the use of generic multi‐pill combinations. In a retrospective study carried out in the USA, investigating Medicare spending on brand‐name combination medications vs their generic constituents, it was found that medical expenses were higher for brand‐name combinations compared with generic constituents . A similar study in Japan would be required to confirm whether the findings are applicable.…”

“…Fixed‐dose triplet combination therapy was not included in the present study, as it has only been in use since 2017. Recently, antihypertensive fixed‐dose triple combination therapy was shown to be well tolerated in Japan; and in Sri Lanka, it was reported to result in an increased proportion of patients achieving their target blood pressure goal versus usual care . It might be necessary to investigate fixed‐dose triplet combination therapy differences in hypertension treatment in future.…”

Assumptions in Clinical Trial Designs and Therapies

“…I selected the topic of assumptions for this month's Note because of a recent article I read. Sacks et al 21 published their paper, Medicare Spending on Brand-name Combination Medications vs Their Generic Constituents, in a July issue of the JAMA. Using 2016 data, they concluded that medication costs could be reduced through better prescriber education and by using appropriate generic and therapeutic substitutions.…”

“…For the treatment of hypertension, Sacks et al 21 propose substituting generic losartan, an angiotensin receptor competitive antagonist, for the more expensive, brand-named azilsartan (Edarbi), also an angiotensin receptor competitive antagonist, with either of these drugs given in combination with chlorthalidone, a generically available, long-acting thiazide diuretic. Readers who remember mechanisms of action may recall that angiotensin receptor competitive antagonists inhibit the binding of angiotensin II to its receptor, which, in turn, inhibits the reabsorption of sodium chloride (salt) from the proximal tubule of the kidney.…”