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

REFERENCES
  1. Reuters. Extended-Release Drugs Could Be Costing US Healthcare System Billions. The New York Times. https://www.nytimes.com/reuters/2020/02/29/us/29reuters-health-medications-costs.html. 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.