Specialty drug spending trends among medicare and medicare advantage enrollees, 2007-11

Health Affairs

Volumn 33, Issue 11, 2014, Pages 2018-2024

  Trish, Erin ^a,b   Joyce, Geoffrey ^a   Goldman, Dana P ^a  

^a UNIVERSITY OF SOUTHERN CALIFORNIA   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTINEOPLASTIC AGENT; MISCELLANEOUS DRUGS AND AGENTS;

AGED; ARTICLE; COST CONTROL; DRUG COST; DRUG USE; HEALTH CARE POLICY; HUMAN; MEDICARE; MOUTH CANCER; PHARMACY; TREND STUDY; ECONOMICS; FEE; HEALTH CARE COST; HEALTH INSURANCE; TRENDS; UNITED STATES;

FEES, PHARMACEUTICAL; HEALTH EXPENDITURES; HUMANS; INSURANCE, PHARMACEUTICAL SERVICES; MEDICARE PART D; UNITED STATES;

EID: 84909589257     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2014.0538     Document Type: Article

References (29)

1. IMS Institute for Healthcare Informatics. Medicine use and shifting costs of healthcare: a review of the use of medicines in the United States in 2013 [Internet]. Parsippany (NJ): IMS Health; 2014 Apr [cited 2014 Sep 25]. Available from: http://www.imshealth.com/cds/ims health/Global/Content/Corporate/IMS%20Health%20Institute/Reports/Secure/IIHI_US_Use_of_ Meds_for_2013.pdf
2. Thomas K. Prices soaring for specialty drugs, researchers find. New York Times. 2014 Apr 15.
3. Editorial Board.Why $1,000 a pill? Our view. USA Today. 2014 Jul 16.
4. Wyden R, Grassley CE. Letter to Dr. John C. Martin [Internet]. Washington (DC): Senate Committee on Finance; 2014 Jul 11 [cited 2014 Sep 25]. Available from: http://www.finance.senate.gov/imo/media/doc/Wyden-Grassley%20 Document%20Request%20to %20Gilead%207-11-141.pdf
5. Kliff S. Each of these hepatitis C pills cost $1,000. That's actually a great deal. Vox [serial on the Internet]. [Updated 2014 Jul 16; cited 2014 Sep 25]. Available from: http://www.vox.com/2014/7/16/5902271/hepatitis-c-drug-sovaldi-price
6. Saab S. Hepatitis C drug worth the price: opposing view. USA Today. 2014 Jul 16.
7. Spatz I, McGee N. Health Policy Brief: Specialty pharmaceuticals. Health Affairs [serial on the Internet]. 2013 Nov 25 [cited 2014 Sep 21]. Available from: http://www.healthaffairs.org/healthpolicy briefs/brief.php?brief_id=103
8. Express Scripts. The 2013 drug trend report [Internet]. St. Louis (MO): Express Scripts Lab; 2014 Apr [cited 2014 Sep 25]. Available from: http://lab.express-scripts.com/~/media/pdfs/drug%20trend%20report/express%20scripts%202013 %20drug%20trend%20report.ashx
9. CVS Caremark. Specialty trend management: where to go next [Internet]. Woonsocket (RI): CVS Health Research Institute; 2013 [cited 2014 Sep 25]. Available from: http://info.cvscaremark.com/sites/default/files/Insights%202013.pdf
10. America's Health Insurance Plans. Specialty drugs-issues and challenges [Internet]. Washington (DC): AHIP; 2014 Feb [cited 2014 Sep 25]. (Issue Brief). Available from: http://www.ahipcoverage.com/wpcontent/uploads/2014/02/Specialty-Drugs-Issue-Brief.pdf
11. The definition used an amount of $500 in 2007.
12. Government Accountability Office. Medicare Part D: spending, beneficiary cost sharing, and cost-containment efforts for high-cost drugs eligible for a specialty tier [Internet]. Washington (DC): GAO; 2010 Jan [cited 2014 Sep 25]. Available from: http://www.gao.gov/assets/310/300528.pdf
13. This group included all elderly beneficiaries who received a low-income subsidy, whether it was full or partial.
14. Hargrave E, Hoadley J, Merrell K. Drugs on specialty tiers in Part D [Internet]. Bethesda (MD): NORC at the University of Chicago; 2009 Feb [cited 2014 Oct 1]. Available from: http://permanent.access.gpo.gov/LPS112283/LPS112283_Feb09_ DrugsonSpecialtyTiers_ CONTRACTOR_RS.pdf
15. The percentage of beneficiaries in our sample who took specialty drugs was 2.7 percent in 2009, 2.1 percent in 2010, and 2.4 percent in 2011.
16. Medicare Payment Advisory Committee. Status report on Part D, with focus on beneficiaries with high drug spending [Internet]. Washington (DC): MedPAC; 2012 Mar [cited 2014 Sep 26]. Available from: http://www.medpac.gov/documents/reports/mar12_ch13.pdf?sfvrsn=0
17. More information on the history of and recent changes to the 340B program is available atWynne B. The coming storm over the 340B Rx drug discount program. Health Affairs Blog [blog on the Internet]. 2014 May 6 [cited 2014 Sep 26]. Available from: http://healthaffairs .org/blog/2014/05/06/the-comingstorm-over-the-340b-rx-drugdiscount-program/
18. Express Scripts. State governments may spend $55 billion on hepatitis C medications [Internet]. St. Louis (MO): Express Scripts Lab; 2014 Jul 17 [cited 2014 Sep 26]. Available from: http://lab.express-scripts .com/insights/specialtymedications/state-governmentsmay-spend-%2455-billion-onhepatitis-c-medications
19. Pollack A. Health insurers pressing down on drug prices. New York Times. 2014 Jun 20.
20. Budnick N. Facing a $168-million price tag for new hepatitis C drugs, Oregon Health Plan balks. Oregonian. 2014 Jun 11.
21. Fendrick AM, Buxbaum J, Westrich K. Supporting consumer access to specialty medications through valuebased insurance design [Internet]. Ann Arbor (MI): University of Michigan Center for Value-Based Insurance Design; [cited 2014 Sep 26]. Available from: http://www.sph.umich.edu/vbidcenter/publications/pdfs/2014-vbidspecialty-medications-npc-finalweb. pdf
22. Goldman DP, Joyce GF, Lawless G, Crown WH, Willey V. Benefit design and specialty drug use. Health Aff (Millwood). 2006;25(5):1319-31.
23. Goldman DP, Jena AB, Lakdawalla DN, Malin JL, Malkin JD, Sun E. The value of specialty oncology drugs. Health Serv Res. 2010;45(1):115-32.
24. Karaca-Mandic P, Joyce GF, Goldman DP, Laouri M. Cost sharing, family health care burden, and the use of specialty drugs for rheumatoid arthritis. Health Serv Res. 2010;45(5 Pt 1):1227-50.
25. Medicare Payment Advisory Committee. Status report on Part D [Internet]. Washington (DC): MedPAC; 2014 Mar [cited 2014 Sep 26]. Available from: http://www .medpac.gov/documents/reports/mar14_ch14.pdf?sfvrsn=0
26. Theodorou AA, Palmieri A, Szychowski JA, Sehman ML, Swarna V. Oral oncology: utilization of selected oral antineoplastic enzyme inhibitor agents. Am J Pharm Benefits. 2012;4(4):178-82.
27. Traditional Medicare has no such limit. However, traditional Medicare beneficiaries may have some sort of annual out-of-pocket maximum if they purchase supplemental coverage such as a Medigap policy.
28. Kaiser Family Foundation. Medicare Advantage [Internet]. Menlo Park (CA): KFF; 2014 May [cited 2014 Sep 26]. (Fact Sheet). Available from: http://kaiserfamily foundation.files.wordpress.com/2014/05/2052-18-medicareadvantage. pdf
29. Jacobson M, Earle CC, Price M, Newhouse JP. How Medicare's payment cuts for cancer chemotherapy drugs changed patterns of treatment. Health Aff (Millwood). 2010;29(7):1391-9.