Total spending on statins, other LDL-C-lowering therapies drops 46% despite uptick in utilization

The number of Medicare beneficiaries being treated with low-density lipoprotein cholesterol (LDL-C)-lowering therapies is on the rise, but much less money is being spent on these medications than in the past. The reason? Clinicians have switched over to prescribing generic formulations, leading to significant savings.

A team of researchers used Medicare Part D data to track the overall utilization of LDL-C-lowering therapies, sharing its findings in JAMA Cardiology.

Overall, the group found, the total number of Medicare beneficiaries being prescribed these medications increased 23% from 2014 to 2018. Total expenditures, however, dropped 46%.

“These findings are particularly relevant as prescription drug costs contribute to the high health care expenditure burden and associated medication nonadherence among patients with atherosclerotic cardiovascular disease,” wrote lead author Andrew Sumarsono, MD, University of Texas Southwestern Medical Center in Dallas, and colleagues. “Substitution of costly brand-name drugs with therapeutically comparable generic formulations has been proposed as an effective strategy to lower medication cost and improve adherence. Our study provides evidence in support of this notion by demonstrating substantial uptake of generic formulations over therapeutically equivalent brand-name counterparts and a concurrent reduction in the associated Medicare and beneficiary expenditure.”

Diving a bit deeper into the data, researchers also noted that statin use increased by 23% from 2014 to 2018, and the use of generic formulations increased 35%. The use of brand-name formulations, meanwhile, dropped a whopping 92%. Overall spending on statins was down 52% from 2014 to 2018.

“Despite these declines, Medicare spent $9.6 billion on brand-name statins during the study period and could have saved an additional $2.1 billion ($1.4 billion with rebates) by switching to equivalent generic options when available,” the authors wrote.

One clear example of the power of a generic formulation is what happened to ezetimibe spending once a generic version hit the market in 2016. Once that new, cheaper version was available, Sumarsono et al. noted, prescriptions for brand-name ezetimibe dropped 96%. In total, spending on ezetimibe decreased 62% from 2014 to 2018.

Total spending on PCSK9 inhibitors, meanwhile, increased 199% from 2014 to 2018.

“The pattern of uptake of PCSK9 inhibitors among Medicare beneficiaries is similar to that observed for other novel cardiovascular therapies,” the authors wrote. “The increasing use may be related to greater coverage of PCSK9 inhibitors by Medicare plans and improved ease of prescribing. However, the price of PCSK9 inhibitors remains high, and future studies are needed to determine if the recent manufacturer-proposed price reductions may accelerate its uptake.”

The full analysis from JAMA Cardiology is available here.