Medicaid spending on antiretrovirals nearly tripled in recent years
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Medicaid spending on antiretrovirals nearly tripled between 2007 and 2019 because of increased antiretroviral use, as well as higher prices, according to a recent study.
“We performed this study because antiretroviral medications to treat HIV remain a major source of Medicaid drug spending decades after these drugs were first introduced,” Benjamin N. Rome, MD, MPH, associate physician at the Harvard Medical School’s division of general internal medicine and primary care and a faculty member of the division of pharmacoepidemiology and pharmacoeconomics, told Healio.
Rome and colleagues identified and assessed trends in antiretroviral spending and use from 2007 through 2019 using public Medicaid State Drug Utilization data. The researchers then estimated net spending and average prices accounting for statutory Medicaid rebates, including a 15% to 23% base rebate plus additional rebates if a drug’s price increased faster than inflation.
The analysis showed that from 2007 to 2019, Medicaid patients used an estimated 17 million 30-day supplies of 48 antiretrovirals. Over the study period, annual use of antiretrovirals increased 118%, from 0.7 million 30-day supplies in 2007 to 1.6 million in 2019.
The most commonly used antiretrovirals in 2007 were emtricitabine/tenofovir (Truvada), efavirenz/emtricitabine/tenofovir (Atripla), and lopinavir/ritonavir, whereas in 2019, the three most commonly used antiretrovirals were all single-tablet regimens introduced between 2014 and 2018 — bictegravir/emtricitabine/tenofovir (Biktarvy), elvitegravir/cobicistat/emtricitabine/tenofovir (Genvoya), and abacavir/dolutegravir/lamivudine (Triumeq).
Among all 48 available antiretrovirals, the estimated net Medicaid spending from 2007 to 2019 was $25 billion for 17 million 30-day supplies. Researchers also found that annual use increased 118%, from 0.7 million 30-day supplies in 2007 to 1.6 million in 2019.
According to the study, estimated annual net spending increased 178% from $1.1 billion to $3 billion, and average net price increased 28%, from $1,432 to $1,830 per 30-day supply during this period.
“Currently, there is a wide variation in the cost of first-line antiretroviral regimens, with some older products now facing generic competition,” Rome said. “To correct this disparity, government programs like Medicare and Medicaid should have the authority to [ensure] that newer medications are priced commensurate ... with existing options.”
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