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Generic initiation and antidepressant therapy adherence under Medicare Part D.

ABSTRACT: To assess the effect of initiating antidepressant therapy with a generic prescription on adherence to antidepressant therapy among Medicare patients. A second objective is to assess how the effect might be moderated by the Medicare Part D coverage gap.Adherence to antidepressant therapy was measured by (a lack of) disruption in medication use defined by a gap of 30 days or more in antidepressant possession and monthly days of possession, both measured over 180 days since antidepressant initiation. We used a 5% random sample of Medicare fee-for-service beneficiaries who received a new depression diagnosis in the first half of 2007 and initiated antidepressant therapy within 60 days (n = 16,778). We estimated a Cox proportional hazard model for antidepressant disruption and a mixedeffects linear model for monthly possession. All analyses were stratified by 4 cohorts defined by Part D low-income subsidy (LIS) status and Medicare entitlement (aged vs disabled).Generic initiation was associated with improved adherence among all 4 cohorts, with a stronger effect among the non-LIS patients. Hazard ratios for antidepressant disruption ranged from 0.71 (95% confidence interval [CI], 0.53-0.96) among non-LIS, disabled patients to 0.88 (95% CI, 0.79-0.98) among LIS, aged patients. Generic initiation was associated with increases in days of monthly possession in all 4 cohorts and an additional benefit during the coverage gap for non-LIS patients.Generic initiation can be an important tool to improve adherence to antidepressant treatment among Medicare patients and to mitigate the negative effects of the Part D coverage gap.

SUBMITTER: Bao Y

PROVIDER: S-EPMC3921685 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

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Generic initiation and antidepressant therapy adherence under Medicare Part D.

Bao Yuhua Y Ryan Andrew M AM Shao Huibo H Pincus Harold Alan HA Donohue Julie M JM

The American journal of managed care 20131201 12

<h4>Objectives</h4>To assess the effect of initiating antidepressant therapy with a generic prescription on adherence to antidepressant therapy among Medicare patients. A second objective is to assess how the effect might be moderated by the Medicare Part D coverage gap.<h4>Study design and methods</h4>Adherence to antidepressant therapy was measured by (a lack of) disruption in medication use defined by a gap of 30 days or more in antidepressant possession and monthly days of possession, both m ...[more]

PMID: 24512035

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Project description:OBJECTIVES:To examine patterns of generic escitalopram initiation and substitution among Medicare beneficiaries. METHODS:This retrospective new user cohort used a 5% random sample of 2013-2015 Medicare administrative claims data. Fee-for-service Medicare beneficiaries continuously enrolled in Parts A, B, and D during a 6-month washout period prior to their initial generic or brand oral escitalopram prescriptions were included (n = 12,351). The primary outcomes were generic escitalopram treatment initiation, and among brand escitalopram initiators, generic substitution within 12 months. Patient demographics, health service utilization, and prescription level factors were measured and assessed. RESULTS:Among all escitalopram initiators, about 88.2% Medicare beneficiaries initiated generic escitalopram. Beneficiaries who were younger age, male, residing in non-Northeast regions or urban area, in the Part D plan deductible benefit phase, and filling prescriptions at community/retail pharmacies were more likely to initiate generic treatment. Among brand escitalopram initiators (n = 1,464), about 20.7% switched to generic escitalopram, 31.2% switched to another alternative antidepressant, 25.1% discontinued treatment, and 8.7% were lost to follow up or passed away within 12 months after brand initiation. Factors associated with generic escitalopram substitution included region (Midwest vs. Northeast, adjusted hazard ratio (HR) = 1.46, 95% CI = 1.04-2.05), pre-index hospitalization (HR = 1.31; 95% CI = 1.16-1.48) and lower escitalopram average daily dosage (HR = 0.97; 95% CI = 0.95-0.99). CONCLUSIONS:In 2013-2015, almost 90% Medicare beneficiaries initiated generic escitalopram treatment. Among brand escitalopram initiators, about 1 in 5 patients switched to generic escitalopram within 1 year, as compared to 1 in 4 or 1 in 3 who discontinued current or switched to alternative treatment, respectively. Medicare beneficiary's geographic region was independently associated with generic escitalopram initiation and substitution. Findings from this study not only provide up-to-date evidence in generic escitalopram use patterns among Medicare population, but also can guide educational and practice interventions to further increase generic escitalopram use.

Project description:ImportanceIn response to scrutiny over high drug prices, manufacturers of insulin and direct-acting antiviral agents for treating hepatitis C have recently introduced authorized generic alternatives to their patented brand-name products. These authorized generic drugs have list prices at least 50% lower than the list price of the brand-name drugs, which should result in savings to patients. However, it is unclear whether these authorized generic drugs are offered on Medicare Part D formularies because they may not provide savings to plans or Medicare.ObjectiveTo assess Medicare Part D formulary coverage for 4 brand-name formulations of insulin and direct-acting antiviral agents and their authorized generic formulations.Design, setting, and participantsThis cross-sectional study used Medicare Prescription Drug Plan Formulary and Pricing Information Files from quarter 3 of 2020 and Medicare Part D plan enrollment for September 2020. Four patented brand-name drugs (sofosbuvir and velpatasvir fixed-dose combination tablets [Epclusa], ledipasvir and sofosbuvir tablets [Harvoni], insulin lispro [Humalog], and insulin aspart [Novolog]) and their authorized generic formulations for all Part D stand-alone prescription drug plans (n = 959) and Medicare Advantage prescription drug plans (n = 3148) were studied.Main outcomes and measuresBeneficiary-weighted formulary coverage of brand-name and authorized generic products; beneficiary out-of-pocket costs; and prerebate plan, manufacturer, and Medicare spending on brand-name and authorized generic products.ResultsIn quarter 3 of 2020, 97% of beneficiaries were in plans that covered brand-name drugs only or both brand-name and authorized generic drugs; approximately 3% were in plans that covered authorized generic drugs only. Observed authorized generic drug list prices were 67%, 62%, and 50% lower than list prices for Epclusa, Harvoni, and each brand-name insulin product, respectively. Medicare beneficiaries using authorized generic drugs could save $270 per year for 12 vials of Humalog and $2974 for a full course of Harvoni. Plans, however, have limited incentives to encourage authorized generic drug use because rebates for brands likely exceed savings available with authorized generic drugs, particularly for beneficiaries with spending that reaches the Medicare Part D coverage gap.Conclusions and relevanceThe results of this cross-sectional study suggest that authorized generic drugs for insulin and direct-acting antiviral agents may lower out-of-pocket spending for patients but are unlikely to provide savings for Part D plans or Medicare. Instead, these drugs allow manufacturers to offer products at a lower list price without materially lowering net prices or profits.

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Generic initiation and antidepressant therapy adherence under Medicare Part D.

Publications

Generic initiation and antidepressant therapy adherence under Medicare Part D.

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