Based on an analysis of Medicare and Medicaid spending between 2012 and 2017, prescriptions for extended-release drugs cost the health care system almost $14 billion more than what would have been spent on equivalent twice-per-day medications, according to a report in JAMA Network Open.1

Ambarish Pandey, MD, and colleagues at the University of Texas Southwestern Medical Center in Dallas looked specifically at drugs with benefits in a twice-a-day version that are equivalent to those of the extended-release version.1

Using the 2012 to 2017 Medicare Part D Drug Event and Medicaid Spending and Utilization data sets, the researchers analyzed 20 extended-release drugs with 37 Medicare formulations and 36 Medicaid formulations. The analyses were conducted from January to December 2019.2

The results showed that in 2017, Medicare Part D spent $2.2 billion and Medicaid spent $952 million, for a combined $3.1 billion, on 20 extended-release drugs. The researchers then estimated that swapping the twice-daily versions for all extended-release formulations would have saved Medicare and Medicaid a total of $2.6 billion during the same time period.2

Over the entire study period, Medicare Part D spent $12 billion on extended-release formulations, whereas Medicaid spent $5.9 billion. The researchers concluded that a switch to a twice-per-day version would have saved $13.7 billion.2

The best way to fix this problem moving forward is for insurers to demand that drug companies reduce extended-release costs to the point where the price is comparable to that of the twice-per-day version, according to Pandey. “If Medicare puts its foot down and says it won’t put the extended-release versions on their formulary unless the price is similar to that of the immediate-release formulations, things will change,” Pandey said in a prepared statement to The New York Times.1

Although Pandey’s study focused on drugs that had a short-acting version with the same therapeutic effects as the extended-release version and only examined short-acting drugs that would be taken twice daily (as opposed to 3 or more times per day), Walid Gellad, MD, MPH, said that this does not mean the drugs are completely comparable.1

“There are many instances where people could use the short-acting form and wouldn’t be burdened with side effects and would do just as well with the extended-release form,” Gellad said in a prepared statement to The New York Times. “One of the main messages for clinicians is that we should always offer the short-acting form to our patients if they can’t afford the long-acting version.”1

  1. Reuters. Extended-Release Drugs Could Be Costing US Healthcare System Billions. The New York Times. Published February 29, 2020. Accessed March 3, 2020.
  2. Sumarsono A, Sumarsono N, Das SR, Vaduganathan M, Agrawal D, Pandey A. Economic Burden Associated With Extended-Release vs Immediate-Release Drug Formulations Among Medicare Part D and Medicaid Beneficiaries. JAMA Netw Open. 2020;3(2):e200181. doi:10.1001/jamanetworkopen.2020.0181.