Assessment of Price Changes of Existing Tumor Necrosis Factor Inhibitors After the Market Entry of Competitors

Abstract

This study uses wholesale medication acquisition costs and Medicare claims data to assess how prices of existing tumor necrosis factor inhibitors changed in response to the market entry of new tumor necrosis factor inhibitors.

Figure 1.. Observed and Expected Trend for the Annual Costs of Treatment With Tumor Necrosis Factor (TNF) Inhibitors, 2006-2016

A, Observed annual costs of treatment with all TNF inhibitors, based on wholesale acquisition costs (WAC). B, Observed annual costs of treatment with all TNF inhibitors, based on Medicare payment data. C, Expected annual costs of treatment with existing TNF inhibitors compared with January 2006, based on WAC. D, Expected annual costs of treatment with existing TNF inhibitors compared with January 2006, based on Medicare payment data. Expected annual costs were estimated from regression models described in the Methods. Estimates based on WACs and Medicare Part D payment data were adjusted for increases in manufacturer rebates reported for Medicare Part D. Period 1 denotes the period before the entry of new drugs (January 2006–April 2009). Period 2 denotes the period between April 2009 (approximately when subcutaneous golimumab and certolizumab pegol entered the market) and July 2013, when intravenous golimumab entered the market. Period 3 denotes the period between the entry of intravenous golimumab in July 2013 and the end of the study period (December 2016). The dotted lines represent the market entries of new TNF inhibitors. All estimates for annual costs of treatment were based on dosing recommendations for a standard 80-kg patient with rheumatoid arthritis. IV indicates intravenous; SQ, subcutaneous. ^aMostly reimbursed under Medicare Part B, and whose annual costs of treatment based on Medicare payment data were estimated using total claim payment amounts under Medicare Part B. ^bMostly reimbursed under Medicare Part D, and whose annual costs of treatment based on Medicare payment data were estimated using gross drug costs under Medicare Part D.

Figure 2.. Observed Trends for the Contribution of Medicare Payments, Out-of-Pocket Costs, Manufacturer Coverage Gap Discounts, and Other Payments Toward Total Annual Costs of Treatment With Tumor Necrosis Factor Inhibitors Covered Under Medicare Part D, 2006-2016

Each panel shows the trend in annual costs of treatment with each tumor necrosis factor inhibitor (A-D) reimbursed under Medicare Part D, which were estimated on the basis of gross drug costs (dark-blue series). Each panel also shows the contribution of Medicare payments, out-of-pocket costs, manufacturer discounts in the coverage gap, and other payments toward total costs. Other payments include Medicare Part D low-income subsidy, payments made by the Part D plan for benefits beyond the standard Part D benefit, payments made by third-party payers (eg, group health plans, worker’s compensation, and governmental programs such as the Veterans Administration and TRICARE), and payments made by qualified state pharmacy assistance programs or charities. Estimates were adjusted for increases in manufacturer rebates reported for Medicare Part D. SQ indicates subcutaneous.