Medicare Part D Utilization, Spending, and Formulary Coverage of Brand-name Disease Modifying Therapies with Generics Available for Multiple Sclerosis
Pengxiang Li1, Matthew Klebanoff1, John Lin2, Keya Doshi3, Salim Chahin4, Jalpa Doshi1
1University of Pennsylvania, 2University of Texas MD Anderson Cancer Center, 3Lexington High School, 4Washington University in St. Louis
Objective:
To examine Medicare Part D utilization, spending, and formulary coverage of brand-name disease modifying therapies (DMTs) with generics available for multiple sclerosis (MS) in 2022.
Background:
DMTs for MS carry substantial price tags, but wider use of generics could lower costs for both payers and patients. Copaxone® and Tecfidera®, two of the most widely used DMTs under Medicare Part D, went generic in 2015 and 2020, respectively. However, the extent of savings will depend on formulary coverage and prescribing by neurologists of brand-name vs. generic counterparts.
Design/Methods:
Using the latest available Medicare Part D Spending Dashboard data and corresponding formulary files, we examined utilization, spending, and formulary coverage for Copaxone® and Tecfidera® vs. their respective generic counterparts (Glatopa/glatiramer acetate and dimethyl fumarate, respectively) in 2022.
Results:
Nearly 50% of the 147,203 prescription fills for brand-name or generic glatiramer acetate were for Copaxone® (representing 4,556 prescribers and 7,922 beneficiaries) even 7 years after generic entry. About 38% of the 105,058 prescription fills for brand-name or generic dimethyl fumarate were for of Tecfidera® (representing 3,070 prescribers and 4,650 beneficiaries) even 2 years after generic entry. Over two-thirds (68%) of the $1.2 billion spending on these two DMTs were for the brand-name products. Nearly one-third (30%) and half (47%) of all Part D plans continued to exclusively cover Copaxone® and Tecfidera®, respectively, on their formularies (i.e. did not cover any generic counterparts).
Conclusions:
Medicare Part D utilization and spending on Copaxone® and Tecfidera® remained high despite the availability of generic counterparts. Future work should evaluate reasons underlying our findings of a large number of plans and prescribers continuing to cover and prescribe, respectively, brand-name DMTs over their generic counterparts. Ongoing monitoring and efforts to increase generic DMT coverage and prescribing will be needed as additional DMTs become generic and changes from Inflation Reduction Act go into effect.
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