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Could an executive order help lower Medicare brand drug prices?

Our Annual Drug Trend Report looks at Medicare brand and generic drug trends

Breaking news of the White House’s consideration of a sweeping executive order that could cut prices on brand-name prescription drugs sold to Medicare and other government programs continues to top this week’s healthcare headlines.

According to Reuters, the order would be “much broader than the Trump Administration's previously disclosed proposal to lower prices on physician administered, or Part B, drugs by tying prices to lower costs in other countries. The administration is now looking at ways to use this or a similar method to lower prices in Medicare's much larger Part D.”

The order reportedly could come within weeks, and it could cover the military healthcare plan as well as the Department of Veterans Affairs, according to White House insider sources at Reuters.

What did Medicare look like in 2018?
Here’s highlights from our Annual Trend Report:

Brand Drugs Driving Medicare Spend

  • Humira and Enbrel held the number 2 and 4 spots respectively for Medicare specialty spend in 2018. With no biosimilars expected until at least 2023, these brands will likely continue to be major components of spend and trend.
  • In Medicare Specialty spend, four oncology agents — Revlimid, Imbruvica, Zytiga, and Ibrance — made the top 10 list.
  • With double-digit increases in trend, four agents — Genvoya, Trimeq, Descovy, and Tivicay — for HIV treatment made the top 10 list for Medicare Specialty in 2018.
  • In 2018, long-acting insulin Lantus claimed the top-ranking per member per year (PMPY) drug for Medicare traditional brand spend.
  • Anti-coagulant agents Eliquis and Xarelto experienced a dramatic increase in both utilization and unit cost, accounting for high double-digit trend in 2018.

Generic Competition Could Lower Prices

  • With generics for Advair Diskus introduced in 2019, expect a significant trend decrease for 2019 and into 2020.
  • Lyrica, approved for seizures, fibromyalgia, and nerve pain (typically caused by diabetes, spinal cord injury, and shingles), ranked 6 and will likely face generic competition in mid-2019.
  • Expanded labeling for Zytiga in early 2018 likely increased utilization, but a generic introduction will decrease brand use in 2019/2020.
 

Want more Medicare insights?

Download our Annual Trend Report for an in-depth look at Medicare as well as Medicaid and commercial drug trends.

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