TY - JOUR
T1 - Medicare beneficiaries' out-of-pocket costs for commonly used generic drugs, 2009-2017
AU - Liu, Patrick
AU - Dhruva, Sanket S.
AU - Shah, Nilay D.
AU - Ross, Joseph S.
N1 - Funding Information:
Source of Funding: Mr Liu received a student research grant from the National Institute on Aging of the National Institutes of Health (award number T35AG049685). The content of this article does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
Author Disclosures: Dr Shah is employed by Mayo Clinic, which is an investor in Civica Rx, a not-for-profit generic drug company; he has received grants from FDA and the Center for Medicare and Medicaid Innovation. Dr Ross has received grants from CMS, FDA, Johnson & Johnson, and the Laura and John Arnold Foundation. Dr Dhruva reports no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.
Publisher Copyright:
© 2020 Ascend Media. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Objectives: To examine differences in the out-of-pocket costs for common generic drugs used to treat chronic conditions when individuals used their Medicare prescription drug plan (PDP) or when purchased through Walmart's generic drug discount programs (GDDPs) from 2009 to 2017. Study Design: A retrospective analysis of Medicare PDP Formulary files and Walmart's GDDP retail drug lists from 2009 to 2017. Methods: We identified all generic drugs used to treat chronic conditions that were on Walmart's GDDP retail drug list from 2009 to 2017. We then determined the out-of-pocket costs for each drug for each Medicare PDP and compared those costs with Walmart's GDDP cash price. Results: There were 62 and 43 generic medications used to treat common chronic diseases available through Walmart's GDDP in 2009 and 2017, respectively. Across all PDPs, the median beneficiary out-of-pocket expenditure for a 30-day supply of the GDDP-available medications for chronic diseases decreased from $5.70 (interquartile range [IQR], $2.55-$7.98) in 2009 to $2.00 (IQR, $0.00-$4.00) in 2017 (P <.001) Approximately three-fifths (60.2%) of PDPs required beneficiaries to pay out-of-pocket costs higher than those of Walmart's GDDP in 2009, but only one-third (33.4%) did so in 2017. Conclusions: Although Medicare beneficiary out-ofpocket costs for commonly used generic drug prescriptions generally decreased over time, Medicare beneficiaries may still be paying more for the same drugs than they would through Walmart's GDDP. Increased generic drug price transparency, including enforcing bans on gag clauses, is needed to ensure that Medicare beneficiaries obtain drugs using the most affordable options.
AB - Objectives: To examine differences in the out-of-pocket costs for common generic drugs used to treat chronic conditions when individuals used their Medicare prescription drug plan (PDP) or when purchased through Walmart's generic drug discount programs (GDDPs) from 2009 to 2017. Study Design: A retrospective analysis of Medicare PDP Formulary files and Walmart's GDDP retail drug lists from 2009 to 2017. Methods: We identified all generic drugs used to treat chronic conditions that were on Walmart's GDDP retail drug list from 2009 to 2017. We then determined the out-of-pocket costs for each drug for each Medicare PDP and compared those costs with Walmart's GDDP cash price. Results: There were 62 and 43 generic medications used to treat common chronic diseases available through Walmart's GDDP in 2009 and 2017, respectively. Across all PDPs, the median beneficiary out-of-pocket expenditure for a 30-day supply of the GDDP-available medications for chronic diseases decreased from $5.70 (interquartile range [IQR], $2.55-$7.98) in 2009 to $2.00 (IQR, $0.00-$4.00) in 2017 (P <.001) Approximately three-fifths (60.2%) of PDPs required beneficiaries to pay out-of-pocket costs higher than those of Walmart's GDDP in 2009, but only one-third (33.4%) did so in 2017. Conclusions: Although Medicare beneficiary out-ofpocket costs for commonly used generic drug prescriptions generally decreased over time, Medicare beneficiaries may still be paying more for the same drugs than they would through Walmart's GDDP. Increased generic drug price transparency, including enforcing bans on gag clauses, is needed to ensure that Medicare beneficiaries obtain drugs using the most affordable options.
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U2 - 10.37765/ajmc.2020.42635
DO - 10.37765/ajmc.2020.42635
M3 - Article
C2 - 32181626
AN - SCOPUS:85082095707
VL - 26
SP - 112
EP - 117
JO - American Journal of Managed Care
JF - American Journal of Managed Care
SN - 1088-0224
IS - 3
ER -