Abstract: PD14-05
Sources of Funding: Ruth L. Kirschstein National Research Service Award 4TL1TR000435 10 (PK)

Introduction

Millions of patients take prescription medications each year for common urologic conditions. Generic and brand name drugs often have widely divergent pricing despite similar therapeutic benefit and side effect profiles. Because prescriptions will only increase as the US population ages, we examined urologist prescription patterns for generic and brand name drugs used to treat three common urologic conditions, and consequent economic implications for Medicare Part D spending.

Methods

We extracted all 2014 urologist prescription claims and payments from the Medicare Part D Prescriber Public Use File. We categorized oral medications used to treat three urological conditions: benign prostate enlargement, erectile dysfunction, and overactive bladder. We then examined total claims, payments, and 30 day cost for each medication with at least 1,000 prescription claims. Last, we estimated the excess annual Medicare Part D payments associated with use of non generic and higher cost medications. We selected a low cost and/or generic drug as a cost comparator for each drug class, then calculated the difference between the actual cost of non comparator drugs and the cost of equivalent length prescriptions of the comparator.

Results

The total claims, total payments, and 30 day cost for medications by urologic condition are shown (Table). Within drugs for benign prostate enlargement, the excess Medicare Part D payment for drugs other than generic tamsulosin or finasteride was $158,935,926. Among erectile dysfunction medications, the excess payment for drugs other than Levitra was $3,105,023. Within drugs for overactive bladder, the excess payment for drugs other than generic oxybutynin extended-release was $248,430,484. The total excess Medicare Part D prescription payment for higher cost and non generic drugs prescribed by urologists in 2014 was $410,471,433.

Conclusions

Among Medicare Part D beneficiaries, we found excess payments for higher cost and non generic drugs prescribed by urologists for three common conditions approached a half billion US dollars. Increasing low cost and generic drug use where available evidence is equivocal represents a promising policy target to reduce Part D medication spending.

Funding

Ruth L. Kirschstein National Research Service Award 4TL1TR000435 10 (PK)