Limits...
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: HIV/AIDS incidence and mortality rates have decreased in the U.S. since 1996.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.


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

License
getmorefigures.php?uid=PMC2147021&req=5

Figure 6: Payment for NNRTI Antiretrovirals by Quarter in Medicaid: 1991–2005.

Mentions: Total U.S. Medicaid expenditure on antiretroviral medications increased from US$ 30.6 million in 1991 to US$ 1.6 billion in 2005, a 49.8-fold increase (Table 3). In 2005, NRTIs as a class had the highest payment market share, accounting for US$ 787.9 million in Medicaid spending (50.8 percent of total spending on antiretrovirals). PIs came in second at US$ 563.5 million (36.3 percent), and NNRTIs were third at US$ 161.6 million (10.4 percent of spending). As of 2005, the FI class accounted for only a 2.5 percent payment market share. Figures 4, 5, and 6 show the trend of payments for each drug in the NRTI, PI, and NNRTI classes, respectively; these figures tell a similar story to that of Figures 1, 2, and 3. The three most costly NRTIs in 2005 quarter 4 were Truvada®, Combivir®, and Viread® (Figure 4). When the first generic antiretroviral, didanosine (for Videx®), became available in 2004, the spending on Videx® decreased from US$ 8.6 million in the fourth quarter of 2004 to US$ 2.6 million in the fourth quarter of 2005. (Note that Videx® is not shown individually in Figure 4; it is part of the category "Other NRTIs.") Meanwhile, the spending on generic didanosine (also among the "Other NRTIs") increased from US$ 15,207 in the fourth quarter of 2004 to US$ 3.2 million in the fourth quarter of 2005. The three most costly PIs in 2005 were Reyataz®, Kaletra®, and Norvir® (Figure 5), while Sustiva® was the market leader in the NNRTI class. The spending on Sustiva® increased from US$ 3,431 in the third quarter of 1998 to US$ 27.0 million in the fourth quarter of 2005 (Figure 6). In 2005, Sustiva® accounted for US$ 114.3 million in Medicaid spending (70.7 percent of spending on NNRTIs) over four quarters.


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)

Payment for 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 6: Payment for NNRTI Antiretrovirals by Quarter in Medicaid: 1991–2005.
Mentions: Total U.S. Medicaid expenditure on antiretroviral medications increased from US$ 30.6 million in 1991 to US$ 1.6 billion in 2005, a 49.8-fold increase (Table 3). In 2005, NRTIs as a class had the highest payment market share, accounting for US$ 787.9 million in Medicaid spending (50.8 percent of total spending on antiretrovirals). PIs came in second at US$ 563.5 million (36.3 percent), and NNRTIs were third at US$ 161.6 million (10.4 percent of spending). As of 2005, the FI class accounted for only a 2.5 percent payment market share. Figures 4, 5, and 6 show the trend of payments for each drug in the NRTI, PI, and NNRTI classes, respectively; these figures tell a similar story to that of Figures 1, 2, and 3. The three most costly NRTIs in 2005 quarter 4 were Truvada®, Combivir®, and Viread® (Figure 4). When the first generic antiretroviral, didanosine (for Videx®), became available in 2004, the spending on Videx® decreased from US$ 8.6 million in the fourth quarter of 2004 to US$ 2.6 million in the fourth quarter of 2005. (Note that Videx® is not shown individually in Figure 4; it is part of the category "Other NRTIs.") Meanwhile, the spending on generic didanosine (also among the "Other NRTIs") increased from US$ 15,207 in the fourth quarter of 2004 to US$ 3.2 million in the fourth quarter of 2005. The three most costly PIs in 2005 were Reyataz®, Kaletra®, and Norvir® (Figure 5), while Sustiva® was the market leader in the NNRTI class. The spending on Sustiva® increased from US$ 3,431 in the third quarter of 1998 to US$ 27.0 million in the fourth quarter of 2005 (Figure 6). In 2005, Sustiva® accounted for US$ 114.3 million in Medicaid spending (70.7 percent of spending on NNRTIs) over four quarters.

Bottom Line: HIV/AIDS incidence and mortality rates have decreased in the U.S. since 1996.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.