Boston—The use of 29 brand-name combination drugs cost Medicare Part D $925 million more in 2016 than if generic components had been purchased separately, according to a new study.

While research has suggested that combo pills offer convenience to patients and increase medication adherence, the study in JAMA questions whether the cost justifies the benefits.

“Generic substitution and therapeutic interchange may offer important opportunities to achieve substantial savings,” suggests the study team led by researchers from Brigham and Women’s Hospital and Harvard Medical School.

To reach that conclusion, the group conducted a retrospective analysis for 2011 through 2016 using the Medicare data set of Part D beneficiaries prescribed any of the 1,500 medications that accounted for the highest total spending in 2015. Included were brand-name combination drugs that had identical or therapeutically equivalent generic constituents.

With 29 brand-name combinations identified, the products were divided into three mutually exclusive categories:
• Constituents available as generic medications at identical doses in 20 of them
• Generic constituents at different doses in three of them, and
• Therapeutically equivalent generic substitutes in six of them.

The study calculates that, instead of the $925 million price tag, the drugs would have cost $235 million if generic products had been prescribed at the same doses, $219 million using generic substitution at different doses, and $471 million from substitution of similar generic medications in the same therapeutic class.

“For the 10 most costly combination products available during the entire study period, the listed Medicare spending could have been an estimated $2.7 billion lower between 2011 and 2016 if the generic constituents had been prescribed,” study authors emphasize.

The article points out that the Centers for Medicare & Medicaid Services is not allowed by law to negotiate prices with manufacturers on behalf of individual Part D plans. In fact, the plans are required to pay for all products in six protected drug classes: immunosuppressants, antineoplastics, antiretrovirals, antipsychotics, antidepressants, and anticonvulsants, study authors write.

 « Click here to return to Weekly News Update.