Earlier this month I published a survey of the cost of insulin to the Medicaid and Medicare programs of Kentucky and the nation. Fully 9.1% of the total cost of Kentucky’s outpatient Medicaid drug program went to pay for the several brands of Insulin still available. It was obvious that some brands cost a lot more per prescription or claim than others and that the most expensive brands were prescribed most often! I used this critically important drug as an example of how the market for prescription drugs in America is badly broken. Since then I stumbled on two additional federal databases that provide additional insight into how much these drugs cost at the local pharmacy counter where the rubber hits the road. These are federal surveys that determine the National Average Retail Prices paid by the consumer (NARP), and the National Average Drug Acquisition Cost (NADAC) for the pharmacy. Both these programs provide data at the cost per milliliter level, and otherwise facilitate apple-to-apple comparisons of the different brands. In brief, the additional data confirm that in 2013, for the same size bottle, the newer insulin analogs cost 71% more than the older “human” insulins. By 2015, all prices had increased; some substantially. Valuable information about the retail prices of drugs is being kept from public inspection. Continue reading “Update On The Rising Prices of Insulin Between 2013 and 2016.”
Discovered and patented almost 100 years ago, insulin is a critical drug for the treatment of both childhood Type I and adult onset Type II diabetes mellitus. Diabetes is a costly disease for our society in more ways than one. In 2015, the cost to the Kentucky Medicaid program for insulin alone annualizes to $101.8 million. Insulin consumed 9.1% of Kentucky Medicaid’s entire non-hospital drug expense while making up only 1.1% of all prescriptions. In 2013, the last year in which Medicare Part-D drug utilization data are available to me, insulin consumed 7.3% of total Medicare reimbursement for drugs in Kentucky costing a total of $141.8 million. In both federal programs, insulin consumed a larger portion of the drug budgets in Kentucky than nationally. A review of several reasons why insulin has become so expensive illustrates what is very wrong with our national drug policy. Continue reading “Soaring Insulin Prices Highlight Broken Pharmaceutical Policy.”
The jointly managed state and federal Medicaid program has always been an important part of the American patchwork healthcare system. The Medicaid expansion of the Affordable Care Act and other changes to eligibility have not only increased the number and diversity of Medicaid beneficiaries, but also Medicaid’s potential financial and clinical ability to shape other healthcare segments in the same way that the Medicare program has done. However, not all of Medicaid’s structural practices may be worth promulgating. I suggest that the way Medicaid has chosen to select eligible drugs for its formularies nor the way its has paid for them are worthy of emulating. To start a new thread in these pages, I begin with a survey of drugs prescribed to Kentucky Medicaid beneficiaries in 2014. I freely admit that I will be learning along with my readers who I hope will participate in the process of exploration and understanding.
I will demonstrate an overlap in the use of drugs by both federal programs but also illustrate major differences. It will be obvious that many beneficiaries who are excluded from employment-based or ineligible for Medicare coverage are dependent on Medicaid for their health care. You might even become more concerned about recent promises to reverse Medicaid expansion and cut its roles. I will highlight the extraordinary cost of some new drugs such as those for the curative treatment of hepatitis-C. I will show that the cost to the system of every-day commonly used drugs overshadows that of the high-flying cancer drugs that are frequently featured in our news reports. You may be surprised to see how frequently opioid narcotics are prescribed. You should be concerned about the exploding costs of necessary and successful medically assisted drug treatment for opioid addiction. You will be as surprised as I at the personal and financial burden of depression and other mental disorders. Finally, you will probably be disappointed and maybe even a little angry about how little our public policy seems to be guided by the prevalence of the illnesses that most frequently affect us. Continue reading “Prescription Drug Utilization and Costs for Kentucky Medicaid in 2014.”
In my last article, I profiled the outpatient drugs prescribed to elderly and disabled Medicare beneficiaries of Kentucky in 2013. While I still had the analytical templates still in hand, I extended that analysis to all 50 states. Initial inspection suggests that the relative pattern of drug prescription (and dispensing) is not greatly different than that of Kentucky. It may not be a surprise that we of the Bluegrass state consume relatively more hydrocodone, oxycodone, and gabapentin relative to other drugs, but less oral anticoagulant. A more granular comparison of Kentucky to the the the nation will require a different approach. This Medicare data allows us to separate out the proportion of a given drug product that is dispensed and billed as a generic drug; a brand name drug; or as alternate preparations such as long-acting, tamper-resistant, or solid vs. liquid. The big take-away for me is that despite the supervision of Medicare’s prescription drug programs by pharmacy benefit managers and others, much money is being spent in less than a medically defensible manner– or is frankly wasted. We as a nation are leaving billions of dollars on the table for pharmaceutical companies and those who market and distribute their products. I will summarize below national utilization and cost figures and make available an Excel file supporting the graphics.
Background. I have been exploring the inaugural release of Medicare prescription drug utilization since its publication last spring. (We should get the numbers from calendar year 2014 in the next few months, but I have Medicaid 2014 in-hand and up-next!). The database does not include all Medicare beneficiaries, only those in Medicare Managed Care or in Medicare Part-D Drug plans, but that makes up a majority of bebefuicuarues. The proportions vary from state to state, but the Medicare programs covers eligible individuals over the age of 65, and some individuals who have been certified as disabled. There is a sizable proportion of individuals who are eligible for both Medicare and Medicaid for other reasons. I frankly do not at present have a good handle on the numbers of beneficiaries in these and other categories that may be included within the present data. Continue reading “Prescription of Medicare Part-D Drugs Nationally: $Billions Left On The Table.”