Sacks CA, et al. - Using a data set made publicly available by the Centers for Medicare & Medicaid Services (CMS), researchers determined the additional cost to Medicare of prescribing brand-name combination medications instead of generic constituents. According to the findings obtained, data on expenditures reported by the Medicare drug benefit program show that the estimated difference between the amount spent on the brand-name combination products and the prices of individual generic or over-the-counter drugs if used for the same number of doses was $925 million in 2016. The study findings suggested that promoting generic substitution and therapeutic interchange through prescriber education and more rational substitution policies might offer important opportunities to achieve substantial savings in the Medicare drug benefit program.

Methods

• Researchers performed retrospective analysis for 2011 through 2016 using the Medicare data set of Part D beneficiaries prescribed any of the 1500 medications that accounted for the highest total spending in 2015.
• They involved brand-name combination drugs that had identical or therapeutically equivalent generic constituents.
• Main exposures were brand-name, oral combination medications with constituents available either as generic drugs or therapeutically equivalent generic substitutes.
• Main outcomes and measures analyzed were the estimated difference between the amount spent by Medicare on brand-name combination drugs and the estimated amount that would have been spent on substitutable generic components.

Results

• Among the 1500 medications assessed, 29 brand-name combination medications were isolated into three mutually exclusive categories:
  • Constituents available as generic medications at identical doses (n = 20),
  • generic constituents at different doses (n = 3),
  • therapeutically equivalent generic substitutes (n = 6).
• Total spending by Medicare in 2016 on the brand-name combination products was $303 million and the estimated spending for the generic constituents would have been $68 million, which is an estimated difference of $235 million for the constituents available as generic medications at identical doses category.
• It was noted that total spending by Medicare in 2016 on the brand-name combination products was $232 million and the estimated spending for the generic constituents would have been $13 million, which is an estimated difference of $219 million for the generic constituents at different doses category.
• They found that total spending by Medicare in 2016 on the brand-name combination products was $491 million and the estimated spending for the generic constituents would have been $20 million, which is an estimated difference of $471 million for the therapeutically equivalent generic substitutes category.
• The estimated spending for the generic constituents for these 29 drugs would have been $925 million less vs the estimated spending for the brand-name combinations in 2016.
• The listed Medicare spending could have been an estimated $2.7 billion lower between 2011 and 2016 if the generic constituents had been prescribed for the 10 most costly combination products available during the entire study period.