Five-Year Trends in Payments for Neurologist-Prescribed Drugs in Medicare Part D

Abstract

Objective:To determine whether there was an increase in payments for neurologist-prescribed drugs, we performed a retrospective analysis of prescription claims in the Medicare Part D Prescriber Public Use Files from 2013-2017.Methods:We included claims prescribed by providers with the taxonomy “Neurology” and included drugs present in all five years. Drugs were designated in 2013 as generic (GEN), brand name only (BNO), and brand name prescribed even though a generic equivalent is available (BNGE). To observe payment trends, the percentage change in the per claim payment was compared between drug classes.Results:We included 520 drugs, of which 322 were GEN, 61 BNO, and 137 BNGE, representing 90,716,536 claims and generating payments of $26,654,750,720. While the number of claims from 2013 to 2017 only increased 7.6%, the total payment increased 50.4%. Adjusted for inflation, claim payments for GEN drug increased 0.6%, compared to significant increases in BNO and BNGE drugs of 42.4% and 45.0% (ptrend<0.001). The percentage of overall GEN claims increased from 81.9% to 88.0%, BNO increased from 4.9% to 6.2%, and BNGE decreased from 13.3% to 5.8%. Neuroimmunology/multiple sclerosis drugs represented over 50% of the total payments despite being only 4.3% of claims.Conclusions:Payments for neurologist-prescribed brand name, but not generic, drugs in Medicare Part D increased consistently and well above inflation from 2013-2017. Unless the overall trend stabilizes or is reversed, or high cost-to-claim drugs are addressed, this trend will place an increasing burden on the neurologic Medicare budget.

Seven Strategies to Integrate Equity within Translational Research in Neurology

“…Completing subsequent phase 1, 2, and 3 trials is costlier, but it could lead to approval for commercialization. These trials are more frequently funded by industry, whose primary motivation of profit/gains for shareholders could be driving higher costs for health care payers 24 . The prioritization of biological and mechanistic research by major funding bodies, leaving implementation science to be mainly influenced by unpredictable market forces, could shape all downstream efforts to achieve equity.…”

Changes in the Use of Brand Name and Generic Medications and Total Prescription Cost Among Medicare Beneficiaries With Epilepsy

“…Still, Medicare represents an important population covering approximately 18% of the US population, 46 particularly relevant for older adults, and our findings are consistent with prior work documenting escalating payments for neurologist-prescribed brand relative to generic medications. 47 Third, identifying epilepsy cases in administrative data sets using ICD codes risks misclassification. 48 Our data crossed over 2015 at which point ICD-9 transitioned to ICD-10 , which could have created some differences in how the population with epilepsy was identified in earlier vs later years.…”

Role of the Bruton Tyrosine Kinase Pathway in Multiple Sclerosis

“…The payment per claim also increased by 46.9% from 2013 to 2017. 24 Between 2017 and 2020, the median cost increase was 5% across all MS DMT classes, including infused and oral therapies. 25 Results from a study of government-insured patients with MS in the United…”