Potential Savings Associated with Drug Substitution in Medicare Part D: The Translating Research into Action for Diabetes (TRIAD) Study
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Drug substitution is a promising approach to reducing medication costs.
To calculate the potential savings in a Medicare Part D plan from generic or therapeutic substitution for commonly prescribed drugs.
Cross-sectional, simulation analysis.
Low-income subsidy (LIS) beneficiaries (n = 145,056) and non low-income subsidy (non-LIS) beneficiaries (n = 1,040,030) enrolled in a large, national Part D health insurer in 2007 and eligible for a possible substitution.
Using administrative data from 2007, we identified claims filled for brand-name drugs for which a direct generic substitute was available. We also identified the 50 highest cost drugs separately for LIS and non-LIS beneficiaries, and reached consensus on which drugs had possible therapeutic substitutes (27 for LIS, 30 for non-LIS). For each possible substitution, we used average daily costs of the original and substitute drugs to calculate the potential out-of-pocket savings, health plan savings, and when applicable, savings for the government/LIS subsidy.
Overall, 39 % of LIS beneficiaries and 51 % of non-LIS beneficiaries were eligible for a generic and/or therapeutic substitution. Generic substitutions resulted in an average annual savings of $160 in the case of LIS beneficiaries and $127 in the case of non-LIS beneficiaries. Therapeutic substitutions resulted in an average annual savings of $452 in the case of LIS beneficiaries and $389 in the case of non-LIS beneficiaries.
Our findings indicate that drug substitution, particularly therapeutic substitution, could result in significant cost savings. There is a need for additional studies evaluating the acceptability of therapeutic substitution interventions within Medicare Part D.
- The Henry J. Kaiser Family Foundation. Medicare Chartbook, Fourth Edition, 2010. Menlo Park, CA: Kaiser Family Foundation. Available at: www.kff.org/medicare/upload/8103.pdf. Accessed December 4, 2012.
- The Henry J. Kaiser Family Foundation. Retail prescription drugs filled at pharmacies (Annual per capita by age), 2009. Menlo Park, CA: Kaiser Family Foundation. Available at: http://www.statehealthfacts.org/comparetable.jsp?ind=268&cat=5. Accessed December 4, 2012.
- Madden JM, Graves AJ, Ross-Degnan D, Briesacher BA, Soumerai SB. Cost-related medication nonadherence after implementation of Medicare Part D, 2006–2007. JAMA. 2009;302:1755–6. CrossRef
- The Henry J. Kaiser Family Foundation. Explaining health care reform: key changes to the Medicare Part D drug benefit coverage gap, 2010. Menlo Park, CA: Kaiser Family Foundation. Available at: http://www.kff.org/healthreform/upload/8059.pdf. Accessed December 4, 2012.
- Aitken M, Berndt ER, Cutler DM. Prescription drug spending trends in the United States: looking beyond the turning point. Health Aff (Millwood). 2009;28:w151–60. CrossRef
- Gilman BH, Kautter J. Impact of multitiered copayments on the use and cost of prescription drugs among Medicare beneficiaries. Health Serv Res. 2008;43:478–95. CrossRef
- Hartman M, Martin A, Nuccio O, Catlin A. Health spending growth at a historic low in 2008. Health Aff (Millwood). 2010;29:147–55. CrossRef
- Zhang JX, Yin W, Sun SX, Alexander GC. The impact of the Medicare Part D prescription benefit on generic drug use. J Gen Intern Med. 2008;23:1673–8. CrossRef
- Levinson DR. Generic drug utilization in the Medicare Part D program. Washington, DC: Department of Health and Human Services, OEI-05-07-00130, 2007. Available at: https://oig.hhs.gov/oei/reports/oei-05-07-00130.pdf. Accessed December 4, 2012.
- Fischer MA, Avorn J. Economic implications of evidence-based prescribing for hypertension: can better care cost less? JAMA. 2004;291:1850–6. CrossRef
- Schneeweiss S, Maclure M, Dormuth CR, Glynn RJ, Canning C, Avorn J. A therapeutic substitution policy for proton pump inhibitors: clinical and economic consequences. Clin Pharmacol Ther. 2006;79:379–88. CrossRef
- Moon JC, Bogle RG. Switching statins. BMJ. 2006;332:1344–5. CrossRef
- Gumbs PD, Verschuren WM, Souverein PC, et al. Society already achieves economic benefits from generic substitution but fails to do the same for therapeutic substitution. Br J Clin Pharmacol. 2007;64:680–5. CrossRef
- American Society of Health-System Pharmacists. ASHP guidelines on medication cost management strategies for hospitals and health systems. Am J Health Syst Pharm. 2008;65:1368–84. CrossRef
- American College of Clinical Pharmacy. ACCP position statement: guidelines for therapeutic interchange. Pharmacotherapy. 2005;25:1666–80. CrossRef
- Cheetham TC, Chan J, Benson V, Richmond C, Levin E, Campen D. Successful conversion of patients with hypercholesterolemia from a brand name to a generic cholesterol-lowering drug. Am J Manag Care. 2005;11:546–52.
- Billups SJ, Plushner SL, Olson KL, Koehler TJ, Kerzee J. Clinical and economic outcomes of conversion of simvastatin to lovastatin in a group-model health maintenance organization. J Manag Care Pharm. 2005;11:681–6.
- Sy FZ, Choe HM, Kennedy DM, et al. Moving from A to Z: successful implementation of a statin switch program by a large physician group. Am J Manag Care. 2009;15:233–40.
- Freeman MK, White W, Iranikhah M. Tablet splitting: a review of weight and content uniformity. Consult Pharm. 2012;27:341–52. CrossRef
- Freeman MK, White W, Iranikhah M. Tablet splitting: a review of the clinical and economic outcomes and patient acceptance. Second of a 2-part series. Consult Pharm. 2012;27:421–30. CrossRef
- Gee M, Hasson NK, Hahn T, Ryono R. Effects of a tablet-splitting program in patients taking HMG-CoA reductase inhibitors: Analysis of clinical effects, patient satisfaction, compliance, and cost avoidance. J Manag Care Pharm. 2002;8:453–8.
- Weissman EM, Dellenbaugh C. Impact of splitting risperidone tablets on medication adherence and on clinical outcomes for patients with schizophrenia. Psychiatr Serv. 2007;58:201–6. CrossRef
- Tseng CW, Buenconsejo-Lum L, Manlucu L, Hixon A. Physicians’ willingness and barriers to considering cost when prescribing. Hawaii Med J. 2006;65(318):320–1.
- Potential Savings Associated with Drug Substitution in Medicare Part D: The Translating Research into Action for Diabetes (TRIAD) Study
Journal of General Internal Medicine
Volume 29, Issue 1 , pp 230-236
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- health care policy
- Industry Sectors
- Author Affiliations
- 1. David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- 4. Department of Health Policy and Management, UCLA Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
- 2. John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
- 3. Pacific Health Research and Education Institute, Honolulu, HI, USA