Cardiometabolic drugs consume majority of cost among those up for price negotiation
Key takeaways:
- Seven cardiometabolic medications incur the most Medicare Part D spending among drugs up for price negotiation.
- The majority of spending on these drugs occurs with the first decade of U.S. market approval.
Among the first 10 drugs selected for price negotiations under the 2022 Inflation Reduction Act, cardiometabolic medications consumed more than 80% of Medicare Part D spending, researchers reported.
Delayed negotiations may incur significant excess federal spending, as more than 60% of total Medicare Part D expenditure on these drugs occurred within the first 9 years of U.S. market introduction, according to new data published in the Journal of the American Heart Association.
The 2022 Inflation Reduction Act
“The 2022 Inflation Reduction Act (IRA) addresses high prescription drug costs by introducing price negotiation for selected Medicare Part D drugs,” Mohammed Essa, MD, internist at the New England Heart and Vascular Institute, Catholic Medical Center in Manchester, New Hampshire, and colleagues wrote. “This policy applies only to small molecule medications beyond 7 years from initial approval and 11 years for biologics, with an approximately 2-year period from drug selection to negotiated prices taking effect. Notably, seven of the first 10 drugs selected for negotiation are for cardiometabolic disease.”
Essa and colleagues used publicly available Medicare part D claims data from 2012 to 2021 to estimate federal spending on the first 10 drugs selected for negotiation per the 2022 IRA: apixaban (Eliquis, Bristol Myers Squibb/Pfizer), rivaroxaban (Xarelto, Janssen/Bayer), sitagliptin (Janumet/Janumet XR, Merck), empagliflozin (Jardiance, Boehringer Ingelheim/Eli Lilly), insulin, sacubitril/valsartan (Entresto, Novartis), dapagliflozin (Farxiga, AstraZeneca), ibrutinib (Imbruvica, Janssen/Pharmacyclics), etanercept (Enbrel, Amgen) and ustekinumab (Stelara, Janssen).
The first seven of these drugs are prescribed to treat various cardiometabolic diseases.
Medicare Part D spending before the IRA
The researchers adjusted total spending for inflation using the consumer price index. Rebates and payments from drug manufacturers to pharmacy benefit managers, while not publicly available, were estimated based on total brand-name drug rebates from Medicare Trustees Reports, according to the study.
Between 2012 and 2021, total claims for the 10 drugs increased 375% from 8.3 million to 39.3 million (P < .001) while total spending on the drugs increased by 690% from $3.5 billion to $27.5 billion (P < .001) and constituted approximately 18% of Medicare Part D expenditures by 2021, the researchers reported.
Between 2015 and 2021, the estimated proportion of the seven cardiometabolic medications on total spending on the 10 drugs increased from 76.1% to 81.7% (P < .001).
The researchers reported that total claims for the seven cardiometabolic medications increased by 386% from 7.9 million in 2012 to 38.6 million in 2021 and constituted 98.3% of all of the 10-drug claims and 14.7% of total Medicare Part D 2021 expenditures by 2021.
During the study period, 60.9% of total spending on the 10 selected drugs occurred within the first 9 years of U.S. market introduction. Apixaban accounted for the highest costs, with a total expenditure of $8.9 billion, or 32.5% of all 10-drug spending in 2021, according to the study.
“Negotiated drug spending will be relevant to the future care of patients with cardiometabolic conditions, as prevalence of heart failure, diabetes and atherosclerotic cardiovascular disease are expected to increase substantially. Importantly, many medications selected for negotiation have class I guideline recommendations,” the researchers wrote. “The delayed start of IRA negotiations poses a significant limitation for cost savings, particularly for therapies that treat cardiometabolic condition.
“Notably, the IRA also limits drug price increases relative to inflation, which may have greater benefits than negotiated cost reductions alone,” they wrote. “The ability of the IRA to contain costs, enhance access, and reduce health disparities for newer therapies will thus be limited by delayed price negotiations.”
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