Use of ACE inhibitor and ARB substitutes could have saved Medicare $676 million in 2016-2017
Broader use of generic angiotensin-II-receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors for hypertension and congestive heart failure could yield millions in healthcare savings, a new study suggested.
In 2016 and 2017 alone, Medicare could have saved about $676 million by using generics or therapeutically interchangeable drugs of the same class, representing about 89.6% of the dollars spent those years on brand-name ARBs and ACE inhibitors, estimated Matthew Growdon, MD, MPH, of Brigham and Women's Hospital in Boston, and colleagues.
For the 2-year study period, $754 million was spent on brand-name versions of these drugs, the bulk of which ($537 million in 2016) came prior to the late-2016 introduction of generic olmesartan (Benicar), they wrote in JAMA Internal Medicine.
Despite generic olmesartan's introduction, however, over $112 million was still spent on that brand-name product in 2017, representing more than $62 million in potential savings. Use of other brand-name ARBs and ACE inhibitors that year represented another $47 million and $20 million, respectively, in missed savings.
Considering that medication spending is a growing burden for a considerable number of patients and accounts for a growing share of U.S. healthcare costs, "it is important for physicians to be aware of the costs to the healthcare system and to their patients related to brand-name drugs as well as potential cost savings that could be realized through increased use of generic drugs," Growdon told MedPage Today.
"This study focused on just a few commonly prescribed cardiovascular medications; the potential savings would be much greater if considering other medication classes, insurers other than Medicare, and a longer time period," Growdon added.
Clinical recommendations for treating patients with heart failure and hypertension do not call for specific ARBs or ACE inhibitors, and there are limited differences between prescriptions, making cost strategies clinically acceptable, the investigators emphasized.
"These findings underscore the value of generic substitution and therapeutic interchange as strategies to contain rising prescription drug costs," the authors wrote.
While these findings aren't surprising, they add to the growing literature on potential savings, noted Kavita Patel, MD, MS, of Johns Hopkins Medicine in Baltimore, who was not involved in the study. She told MedPage Today that the research comes "on the heels of aggressive policy movement in prescription drugs costs" and "make for a ripe policy window to enact change."
"There needs to be a lot more education as well as better integration of options around generics at every point of clinical interaction, particularly education around the fact that not every generic is created equal in terms of cost," Patel continued.
And switching to generic ARBs has not been without issue, as a number of reports have surfaced over the past 2 years indicating that lots of generic losartan, valsartan, and irbesartan have been contaminated with nitrosamines and other carcinogens.
For the current study, Growdon's group used the Medicare Part D Prescription Drug Event information set to estimate brand-name ARB and ACE inhibitor expenditures for 2016 and 2017, excluding combination products. They then compared them to the overall cost of therapeutically similar or identical generic products. Although in some cases there were brand-name ARBs without identical generic equivalents, candesartan (Atacand) and losartan (Cozaar) can be used interchangeably.
Prescriptions for brand-name ACE inhibitors that had generic alternatives were filled by 7,567 and 8,694 Medicare Part D beneficiaries in 2017 and 2016, respectively, costing $20.9 million and $21.3 million in those years.
For brand-name ARBs, 49,396 and 116,551 beneficiaries filled prescriptions in 2016 and 2017, respectively, costing $63.6 million and $165.2 million.
Finally, for ARBs with interchangeable therapies, olmesartan and azilsartan (Edarbi), there were 287,016 and 13,588 Medicare beneficiaries that filled prescriptions for brand-name products in 2016 and 2017, respectively, costing $452.2 million and $17.1 million.
Limitations of the study included varying prescribing rebates, practices, and prices for other insurers and Medicare Part D, the researchers noted.
The study was funded by the Carney Family Foundation, the Engelberg Foundation, the Harvard-MIT Center for Regulatory Science, and Arnold Ventures.
Growdon reported no disclosures.
Patel disclosed relationships with New Enterprise Associates.
JAMA Internal Medicine
Source Reference: Growdon ME, et al "Potential medicare savings from generic substitution and therapeutic interchange of ACE
inhibitors and angiotensin-II-receptor blockers" JAMA Intern Med 2019; DOI: 10.1001/jamainternmed.2019.3107.
Read the original article on Medpage Today: More Aggressive Switch to Generic BP Meds Could Save Medicare $$