Medicaid osteoporosis drugs utilization and expenditures: the effect of generic drugs market entry

Abstract

Objectives: This study assessed secular trends in utilization, expenditures and market share of all FDA approved osteoporosis drugs in the Medicaid fee-for-service program in the period 1995–2014. Methods: Study data for all osteoporosis drugs approved by the FDA in the study period were derived from the Drug@FDA database. Drug utilization data were obtained from the Centers for Medicare and Medicaid Services. This study included all fee-for-service pharmacy claims for all Medicaid outpatient drugs dispensed in the United States. Analysis of osteoporosis drug utilization was performed at the level of the individual drug and by therapeutic subclasses. Findings: In the period 1995–2014, the FDA approved a total of 11 osteoporosis drugs including nine different single active ingredients and two combinations. The osteoporosis drug utilization increased from 30 000 defined daily doses (DDDs) in 1995 to 7.9 million DDDs in 2005 remained stagnant in 2007–2010, and declined thereafter. Medicaid expenditures on osteoporosis drugs increased from $12.3 million in 1995 to $158.6 million in 2006 and significantly decrease thereafter. Medicare Part D resulted in a significant reduction in the Medicaid utilization of osteoporosis drugs. The average Medicaid reimbursement rate per DDD significantly decreased after the entry of bisphosphonates in the US market in 1995. Conclusions: In the study period, the generic market share of osteoporosis drugs was relatively small compared to other therapeutic classes and health insurance programs. Higher use of generic osteoporosis drugs could improve the efficiency of the Medicaid program, reduce overall pharmaceutical expenditures and improve access to affordable pharmaceuticals.