New findings were published in the Annals of Internal Medicine from a retrospective cohort study comparing overall and regional rates of brand-name drug use among older adults with diabetes in Medicare, which relies on private plans with distinct formularies,and the VA, which administers its own benefit using a national formulary.
The researchers focused on comparing 1)the percentage of patients taking oral hypoglycemics, statins, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) who filled brand-name drug prescriptions and percentage of patients taking long-acting insulins who filled analogue prescriptions; 2)Sociodemographic- and health status–adjusted hospital referral region (HRR) brand-name drug use; and 3)changes in spending if brand-name drug use in one system mirrored the other.
Although the researchers admit that their analysis could not fully describe the factors underlying differences in brand-name drug use, they did find that Medicare beneficiaries with diabetes use 2 to 3 times more brand-name drugs than a comparable group within the VA, at substantial excess cost:
- 35.3% versus 12.7% for oral hypoglycemics
- 50.7% versus 18.2% for statins,
- 42.5% versus 20.8% for ACE inhibitors or ARBs,
- 75.1% versus 27.0% for insulin analogues.
- Adjusted HRR-level brand-name statin use ranged (from the 5th to 95th percentiles) from 41.0% to 58.3% in Medicare and 6.2% to 38.2% in the VA. For each drug group, the 95th-percentile HRR in the VA had lower brand-name drug use than the 5th-percentile HRR in Medicare.
- Medicare spending in this population would have been $1.4 billion less if brand-name drug use matched that of the VA.
Source: Gellad, W.F., et al. (2013). Brand-name prescription drug use among veteran affairs and medicare part d patients with diabetes: A national cohort comparison. Annals of Internal Medicine, doi:10.7326/0003-4819-159-2-201307160-00664.