Applying Oncology Formulary and Benefit Design Innovations to the Management of Multiple Myeloma in the Managed Care Setting

Cannon, H. Eric

doi:10.18553/jmcp.2012.18.s8-a.s13

Cited by 1 publication

(1 citation statement)

References 38 publications

(47 reference statements)

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“…These challenges also can be addressed by including comparative effectiveness research (CER) to evaluate the relative benefits and risks of different treatment options. Furthermore, adopting patient-centered healthcare delivery models that prioritize individual preferences and values, as well as designing oncology drug benefit programs, can optimize both clinical outcomes and cost-effectiveness [ 38 ]. Incorporating patient-reported outcomes (PROs) into the care of patients with MM shows promise in improving the quality and cost-effectiveness of treatment [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Drug Expenditure, Price, and Utilization in US Medicaid: A Trend Analysis for New Multiple Myeloma Medications from 2016 to 2022

et al. 2023

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Introduction: Multiple myeloma (MM) is the most common plasma cell tumor type. In late 2015, the FDA approved three new medications for MM. These medications were ixazomib, daratumumab, and elotuzumab. However, their utilization, reimbursement, and price in the Medicaid program have not been analyzed before. Methods: A retrospective drug utilization study using the national Medicaid pharmacy claims data from 2016 to 2022 in the US. The primary metrics of analysis were utilization (number of prescriptions), reimbursement (total spending), and price (reimbursement per prescription). Results: The overall Medicaid utilization of MM medications increased from 1671 prescriptions in 2016 to 34,583 prescriptions in 2022 (1970% increase). Moreover, the overall Medicaid reimbursement for the new MM medications increased from USD 9,250,000 in 2016 to over USD 214,449,000 in 2022 (2218% increase). Daratumumab had much higher utilization, reimbursement, and market shares than its competitors. Ixazomib was the most expensive medication compared to daratumumab and elotuzumab. Conclusion: The results of this study demonstrate that CMS utilization and spending on MM medications have significantly grown since 2016. Daratumumab has by far the highest utilization, spending, and market share. The utilization of and spending on specific pharmaceuticals are clearly impacted by policy and clinical guideline recommendations.

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Section: Discussionmentioning

confidence: 99%