Exploring Human Potential

Mylan EpiPen? What About Medicare Part D?

Posted on | August 25, 2016 | No Comments

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Mike Magee

Pediatric drug prices have led the news recently with the fantastic and purposeful price escalation of Mylan’s EpiPen. With all that going on, it would have been easy to miss the analysis of the complete Medicare Part D year over year costs (2014 vs. 2013) that were recently released. 70% of Medicare patients carry Part D policies. The others are enrolled in Medicare Advantage plans or “stand-alone prescription drug plans”.

Here’s a summary:

1. Total billing tic’d up a bit over 17%, with total health care claims up 3.3% by way of comparison. 12.6% of this was from prescription drugs. CMS delivered $121 billion in 2014 compared to $103 billion in 2013.

2. Nine of the top ten drug contenders (by numbers of claims, not total cost) were unchanged from 2013, and all ten were generics. #1 generated a spend of $748 million. #10 a mere $136 million.

3. If you look at cost, however, the top ten in 2014 were all brand name. In the lead, as you might guess was the Solvaldi Hep C star with a $3.1 billion spend. Then came Nexium (antacid), Crestor (cholesterol), Abilify (depression), Advair (bronchitis/asthma), Spiriva (COPD), Lantus SoloSTAR(insulin pen), Januvia(Type 2 Diabetes), Lantus (insulin pen), Revlimid (anemia). Each of these drew more than $1 billion.

4. There were over 1 million prescribing health professionals.

5. Medicare patients who chose brand name over generics on average pay co-pays that are 10 times higher than they need to. 


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