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Utilization and costs of medications associated with CKD mineral and bone disorder in dialysis patients enrolled in Medicare Part D.


ABSTRACT: Information is limited regarding utilization patterns and costs for chronic kidney disease-mineral and bone disorder (CKD-MBD) medications in Medicare Part D-enrolled dialysis patients.Retrospective cohort study.Annual cohorts of dialysis patients, 2007-2010.Cohort year, low-income subsidy status, and dialysis provider.Utilization and costs of prescription phosphate binders, oral and intravenous vitamin D analogues, and cinacalcet.Using logistic regression, we calculated adjusted odds of medication use for low-income subsidy versus non-low-income subsidy patients and for patients from various dialysis organizations, and we report per-member-per-month and average out-of-pocket costs.Phosphate binders (?83%) and intravenous vitamin D (77.5%-79.3%) were the most commonly used CKD-MBD medications in 2007 through 2010. The adjusted odds of prescription phosphate-binder, intravenous vitamin D, and cinacalcet use were significantly higher for low-income subsidy than for non-low-income subsidy patients. Total Part D versus CKD-MBD Part D medication costs increased 22% versus 36% from 2007 to 2010. For Part D-enrolled dialysis patients, CKD-MBD medications represented ?50% of overall net Part D costs in 2010.Inability to describe utilization and costs of calcium carbonate, an over-the-counter agent not covered under Medicare Part D; inability to reliably identify prescriptions filled through a non-Part D reimbursement or payment mechanism; findings may not apply to dialysis patients without Medicare Part D benefits or with Medicare Advantage plans, or to pediatric dialysis patients; could identify only prescription drugs dispensed in the outpatient setting; inability to adjust for MBD laboratory values.Part D net costs for CKD-MBD medications increased at a faster rate than costs for all Part D medications in dialysis patients despite relatively stable use within medication classes. In a bundled environment, there may be incentives to shift to generic phosphate binders and reduce cinacalcet use.

SUBMITTER: Yusuf AA 

PROVIDER: S-EPMC4209315 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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Utilization and costs of medications associated with CKD mineral and bone disorder in dialysis patients enrolled in Medicare Part D.

Yusuf Akeem A AA   Howell Benjamin L BL   Powers Christopher A CA   St Peter Wendy L WL  

American journal of kidney diseases : the official journal of the National Kidney Foundation 20140513 5


<h4>Background</h4>Information is limited regarding utilization patterns and costs for chronic kidney disease-mineral and bone disorder (CKD-MBD) medications in Medicare Part D-enrolled dialysis patients.<h4>Study design</h4>Retrospective cohort study.<h4>Setting & participants</h4>Annual cohorts of dialysis patients, 2007-2010.<h4>Predictors</h4>Cohort year, low-income subsidy status, and dialysis provider.<h4>Outcomes</h4>Utilization and costs of prescription phosphate binders, oral and intrav  ...[more]

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