. 2019 Oct 16;19(1):703.

doi: 10.1186/s12913-019-4520-4.

Association between physician adoption of a new oral anti-diabetic medication and Medicare and Medicaid drug spending

Ilinca D Metes¹, Lingshu Xue², Chung-Chou H Chang^{3

4}, Haiden A Huskamp⁵, Walid F Gellad^{3

6

7}, Wei-Hsuan Lo-Ciganic⁸, Niteesh K Choudhry⁹, Seth Richards-Shubik¹⁰, Hasan Guclu¹¹, Julie M Donohue^{12

13}

Affiliations

¹ Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA.
² Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA.
³ Department of Medicine, School of Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15213, USA.
⁴ Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
⁵ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
⁶ Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
⁷ Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15215, USA.
⁸ Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA.
⁹ Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA.
¹⁰ College of Business and Economics, Lehigh University, Rausch Business Center, Room 465, 621 Taylor St, Bethlehem, PA, 18015, USA.
¹¹ Department of Statistics, School of Science, Istanbul Medeniyet University, Uskudar, 34700, Istanbul, Turkey.
¹² Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA. jdonohue@pitt.edu.
¹³ Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A635, Pittsburgh, PA, 15261, USA. jdonohue@pitt.edu.

PMID: 31619229
PMCID: PMC6794771
DOI: 10.1186/s12913-019-4520-4

Association between physician adoption of a new oral anti-diabetic medication and Medicare and Medicaid drug spending

Ilinca D Metes et al. BMC Health Serv Res. 2019.

. 2019 Oct 16;19(1):703.

doi: 10.1186/s12913-019-4520-4.

Authors

Affiliations

¹ Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA.
² Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA.
³ Department of Medicine, School of Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15213, USA.
⁴ Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
⁵ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA.
⁶ Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA.
⁷ Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15215, USA.
⁸ Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA.
⁹ Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA.
¹⁰ College of Business and Economics, Lehigh University, Rausch Business Center, Room 465, 621 Taylor St, Bethlehem, PA, 18015, USA.
¹¹ Department of Statistics, School of Science, Istanbul Medeniyet University, Uskudar, 34700, Istanbul, Turkey.
¹² Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA. jdonohue@pitt.edu.
¹³ Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A635, Pittsburgh, PA, 15261, USA. jdonohue@pitt.edu.

PMID: 31619229
PMCID: PMC6794771
DOI: 10.1186/s12913-019-4520-4

Abstract

Background: In the United States, there is well-documented regional variation in prescription drug spending. However, the specific role of physician adoption of brand name drugs on the variation in patient-level prescription drug spending is still being investigated across a multitude of drug classes. Our study aims to add to the literature by determining the association between physician adoption of a first-in-class anti-diabetic (AD) drug, sitagliptin, and AD drug spending in the Medicare and Medicaid populations in Pennsylvania.

Methods: We obtained physician-level data from QuintilesIMS Xponent™ database for Pennsylvania and constructed county-level measures of time to adoption and share of physicians adopting sitagliptin in its first year post-introduction. We additionally measured total AD drug spending for all Medicare fee-for-service and Part D enrollees (N = 125,264) and all Medicaid (N = 50,836) enrollees with type II diabetes in Pennsylvania for 2011. Finite mixture model regression, adjusting for patient socio-demographic/clinical characteristics, was used to examine the association between physician adoption of sitagliptin and AD drug spending.

Results: Physician adoption of sitagliptin varied from 44 to 99% across the state's 67 counties. Average per capita AD spending was $1340 (SD $1764) in Medicare and $1291 (SD $1881) in Medicaid. A 10% increase in the share of physicians adopting sitagliptin in a county was associated with a 3.5% (95% CI: 2.0-4.9) and 5.3% (95% CI: 0.3-10.3) increase in drug spending for the Medicare and Medicaid populations, respectively.

Conclusions: In a medication market with many choices, county-level adoption of sitagliptin was positively associated with AD spending in Medicare and Medicaid, two programs with different approaches to formulary management.

Keywords: Diabetes; Medicaid; Medicare; Physician behavior; Prescription drugs; Technology adoption.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Raw and Log-Transformed Anti-Diabetic Drug Spending Distributions for the Medicare and Medicaid Study Samples (2011)

**Fig. 2**
Measures of Sitagliptin Adoption by Pennsylvania County

See this image and copyright information in PMC

References

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Association between physician adoption of a new oral anti-diabetic medication and Medicare and Medicaid drug spending

Affiliations

Association between physician adoption of a new oral anti-diabetic medication and Medicare and Medicaid drug spending

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical