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Utilization and spending trends for antiretroviral medications in the U.S. Medicaid program from 1991 to 2005.

Jing Y, Klein P, Kelton CM, Li X, Guo JJ - AIDS Res Ther (2007)

Bottom Line: Payment per prescription for each drug, with the exception of Agenerase, increased, at least somewhat, over time.The relatively expensive drugs in 2005 included Trizivir ($1040) and Combivir ($640), as well as Reyataz ($750), Lexiva ($700), Sustiva ($420), Viramune ($370), and Fuzeon ($1914).The tremendous growth in antiretroviral spending is due primarily to rising utilization, secondarily to the entry of newer, more expensive antiretrovirals, and, finally, in part to rising per-prescription cost of existing medications.

View Article: PubMed Central - HTML - PubMed

Affiliation: College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA. jingy@email.uc.edu

ABSTRACT

Background: HIV/AIDS incidence and mortality rates have decreased in the U.S. since 1996. Accompanying the longer life spans of those diagnosed with the disease, however, is a tremendous rise in expenditures on medication. The objective of this study is to describe the trends in utilization of, spending on, and market shares of antiretroviral medications in the U.S. Medicaid Program. Antiretroviral drugs include nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), and fusion inhibitors (FIs).

Methods: Utilization and payment data from 1991 to 2005 are provided by the Centers for Medicare & Medicaid Services. Descriptive summary analyses were used to assess quarterly prescription numbers and amounts of payment.

Results: The total number of prescriptions for antiretrovirals increased from 168,914 in 1991 to 2.0 million in 1998, and 3.0 million in 2005, a 16.7-fold increase over 15 years. The number of prescriptions for NRTIs reached 1.6 million in 2005. Prescriptions for PIs increased from 114 in 1995 to 932,176 in 2005, while the number of prescriptions for NNRTIs increased from 1,339 in 1996 to 401,272 in 2005. The total payment for antiretroviral drugs in the U.S. Medicaid Program increased from US$ 30.6 million in 1991 to US$ 1.6 billion in 2005, a 49.8-fold increase. In 2005, NRTIs as a class had the highest payment market share. These drugs alone accounted for US$ 787.9 million in Medicaid spending (50.8 percent of spending on antiretrovirals). Payment per prescription for each drug, with the exception of Agenerase, increased, at least somewhat, over time. The relatively expensive drugs in 2005 included Trizivir ($1040) and Combivir ($640), as well as Reyataz ($750), Lexiva ($700), Sustiva ($420), Viramune ($370), and Fuzeon ($1914).

Conclusion: The tremendous growth in antiretroviral spending is due primarily to rising utilization, secondarily to the entry of newer, more expensive antiretrovirals, and, finally, in part to rising per-prescription cost of existing medications.

No MeSH data available.


Related in: MedlinePlus

Utilization of NNRTI Antiretrovirals by Quarter in Medicaid: 1991–2005.
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Figure 3: Utilization of NNRTI Antiretrovirals by Quarter in Medicaid: 1991–2005.

Mentions: The total number of antiretroviral prescriptions paid for by Medicaid increased from 168,914 in 1991 to 3.0 million in 2005, showing a 16.7-fold increase over 15 years (see Table 2). In 1996, and again in 1997, utilization of antiretrovirals increased by more than 100 percent in a single year. The number of prescriptions for NRTIs increased from 168,914 in 1991 to 1.6 million in 2005. Prescriptions for PIs increased from 114 in 1995 to 932,176 in 2005. The number of prescriptions for NNRTIs increased from 1,339 in 1996 to 401,272 in 2005. The prescriptions for the most recent class of antiretrovirals, the FIs, increased from 6,683 in 2003 to 20,391 in 2005, representing a 205.1 percent increase in just two years. As shown in Figure 1, in 2005 quarter 4, the three NRTI market leaders were Viread® with 62,513 prescriptions, Combivir® with 56,735 prescriptions, and Truvada® with 54,788 prescriptions. Included in "Other NRTIs" (each with no more than 17,000 prescriptions in 2005 quarter 4) are the two original NRTIs, Retrovir® and Videx®, which still play some role in the Medicaid market. In 2005 quarter 4, Medicaid prescriptions for Retrovir® totaled 9,970, while those for Videx® plus didanosine totaled 28,213. Figure 2 shows the three PI market leaders. In 2005 quarter 4, there were 58,605 prescriptions for Norvir®, 56,327 prescriptions for Kaletra®, and 51,973 prescriptions for Reyataz®. Most of the "Other PIs" (again, each with no more than 17,000 prescriptions in 2005 quarter 4), with the exception of the newest entrant Aptivus®, have experienced a declining number of prescriptions over time, as can be seen in Figure 2. Finally, Figure 3 identifies Sustiva® as the NNRTI market leader in 2005.


Utilization and spending trends for antiretroviral medications in the U.S. Medicaid program from 1991 to 2005.

Jing Y, Klein P, Kelton CM, Li X, Guo JJ - AIDS Res Ther (2007)

Utilization of NNRTI Antiretrovirals by Quarter in Medicaid: 1991–2005.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2147021&req=5

Figure 3: Utilization of NNRTI Antiretrovirals by Quarter in Medicaid: 1991–2005.
Mentions: The total number of antiretroviral prescriptions paid for by Medicaid increased from 168,914 in 1991 to 3.0 million in 2005, showing a 16.7-fold increase over 15 years (see Table 2). In 1996, and again in 1997, utilization of antiretrovirals increased by more than 100 percent in a single year. The number of prescriptions for NRTIs increased from 168,914 in 1991 to 1.6 million in 2005. Prescriptions for PIs increased from 114 in 1995 to 932,176 in 2005. The number of prescriptions for NNRTIs increased from 1,339 in 1996 to 401,272 in 2005. The prescriptions for the most recent class of antiretrovirals, the FIs, increased from 6,683 in 2003 to 20,391 in 2005, representing a 205.1 percent increase in just two years. As shown in Figure 1, in 2005 quarter 4, the three NRTI market leaders were Viread® with 62,513 prescriptions, Combivir® with 56,735 prescriptions, and Truvada® with 54,788 prescriptions. Included in "Other NRTIs" (each with no more than 17,000 prescriptions in 2005 quarter 4) are the two original NRTIs, Retrovir® and Videx®, which still play some role in the Medicaid market. In 2005 quarter 4, Medicaid prescriptions for Retrovir® totaled 9,970, while those for Videx® plus didanosine totaled 28,213. Figure 2 shows the three PI market leaders. In 2005 quarter 4, there were 58,605 prescriptions for Norvir®, 56,327 prescriptions for Kaletra®, and 51,973 prescriptions for Reyataz®. Most of the "Other PIs" (again, each with no more than 17,000 prescriptions in 2005 quarter 4), with the exception of the newest entrant Aptivus®, have experienced a declining number of prescriptions over time, as can be seen in Figure 2. Finally, Figure 3 identifies Sustiva® as the NNRTI market leader in 2005.

Bottom Line: Payment per prescription for each drug, with the exception of Agenerase, increased, at least somewhat, over time.The relatively expensive drugs in 2005 included Trizivir ($1040) and Combivir ($640), as well as Reyataz ($750), Lexiva ($700), Sustiva ($420), Viramune ($370), and Fuzeon ($1914).The tremendous growth in antiretroviral spending is due primarily to rising utilization, secondarily to the entry of newer, more expensive antiretrovirals, and, finally, in part to rising per-prescription cost of existing medications.

View Article: PubMed Central - HTML - PubMed

Affiliation: College of Pharmacy, University of Cincinnati Medical Center, Cincinnati, Ohio, USA. jingy@email.uc.edu

ABSTRACT

Background: HIV/AIDS incidence and mortality rates have decreased in the U.S. since 1996. Accompanying the longer life spans of those diagnosed with the disease, however, is a tremendous rise in expenditures on medication. The objective of this study is to describe the trends in utilization of, spending on, and market shares of antiretroviral medications in the U.S. Medicaid Program. Antiretroviral drugs include nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), and fusion inhibitors (FIs).

Methods: Utilization and payment data from 1991 to 2005 are provided by the Centers for Medicare & Medicaid Services. Descriptive summary analyses were used to assess quarterly prescription numbers and amounts of payment.

Results: The total number of prescriptions for antiretrovirals increased from 168,914 in 1991 to 2.0 million in 1998, and 3.0 million in 2005, a 16.7-fold increase over 15 years. The number of prescriptions for NRTIs reached 1.6 million in 2005. Prescriptions for PIs increased from 114 in 1995 to 932,176 in 2005, while the number of prescriptions for NNRTIs increased from 1,339 in 1996 to 401,272 in 2005. The total payment for antiretroviral drugs in the U.S. Medicaid Program increased from US$ 30.6 million in 1991 to US$ 1.6 billion in 2005, a 49.8-fold increase. In 2005, NRTIs as a class had the highest payment market share. These drugs alone accounted for US$ 787.9 million in Medicaid spending (50.8 percent of spending on antiretrovirals). Payment per prescription for each drug, with the exception of Agenerase, increased, at least somewhat, over time. The relatively expensive drugs in 2005 included Trizivir ($1040) and Combivir ($640), as well as Reyataz ($750), Lexiva ($700), Sustiva ($420), Viramune ($370), and Fuzeon ($1914).

Conclusion: The tremendous growth in antiretroviral spending is due primarily to rising utilization, secondarily to the entry of newer, more expensive antiretrovirals, and, finally, in part to rising per-prescription cost of existing medications.

No MeSH data available.


Related in: MedlinePlus