Hepatitis C, HIV Drugs Remain Number One in Outpatient Medicaid Spending

Antiviral drugs, including therapies for hepatitis C virus (HCV) and HIV, remained the most consistently costly drug group by Medicaid spending over a 4-year study period, according to a recent Kaiser Family Foundation analysis.
The analysis examined Medicaid outpatient prescription drug utilization in terms of prescriptions and spending before rebates over the 2014 to 2017 period.
Medicaid outpatient spending before rebates increased from $45.9 billion in 2014 to $63.6 billion in 2017, growing a total of 39%, according to the analysis. Overall, spending on outpatient services increased by 21% in 2015 and an additional 11% in 2016, but grew more slowly in 2017. However, the study authors noted that they anticipate this spending to grow faster than other Medicaid services over the next 10 years. Additionally, utilization grew from 621.7 million prescriptions in 2014 to 752.9 million in 2017, increasing a total of 21% over the study period.
Eight of the 10 costliest drug groups remained consistent every year but shifted in order of ranking.  
In 2017, the data showed that antiviral medications accounted for nearly 14% of Medicaid outpatient drug spending. This drug group held the top spot in the ranking consistently across the 4-year period. Among antivirals, drugs used to treat HCV and HIV accounted for more than 90% of Medicaid antiviral spending before rebates. However, spending on these medications, particularly HCV drugs, was also found to be disproportionate to their utilization.
“Medicaid is the largest source of coverage for people with HIV, covering over 280,000 people, or an estimate of more than 40% of people with HIV,” the authors wrote. “Of the up to 5 million people in the US with hepatitis C, a disproportionate number are enrolled in Medicaid.”
From 2014 to 2017, HCV drugs made up a relatively large share ($3.2 billion) of antiviral spending despite being prescribed the least.
Diabetes treatments became the second largest share of spending by 2017, nearly doubling in spend over the study period. This is largely due to the increasing prices of insulin and lack of generic options, the researchers explained. Other drug groups included in the highest-spend ranking were antiasthmatic and bronchodilator agents, antipsychotic/antimanic agents, dermatologicals, and anti-inflammatory agents.
Opioids were the most prescribed drug group in 2014, but prescriptions declined over time. By 2017, antidepressants took the top spot as the most prescribed drug group in the Medicaid population.
Other highly utilized drugs include treatments for asthma and chronic obstructive pulmonary disease, anticonvulsants, narcotic and nonnarcotic painkillers, antihypertensives, ulcer drugs, antidiabetics, antihistamines, and dermatologicals.
With Medicaid drug spending expected to surge, the researchers indicated that continued state- and federal-level actions are needed to address concerns over high-cost medications.
“Because states must balance their budgets, ongoing increased spending on Medicaid prescription drugs is a policy concern, prompting states to consider ways to reduce drug spending,” the authors wrote. “Understanding patterns and trends in drug spending is crucial to effectively managing the benefit and developing strategies to address high drug costs.”
Young K. Utilization and Spending Trends in Medicaid Outpatient Prescription Drugs. Kaiser Family Foundation. Published February 15, 2019. https://www.kff.org/medicaid/issue-brief/utilization-and-spending-trends-in-medicaid-outpatient-prescription-drugs/. Accessed March 4, 2019.

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A recent study demonstrates the clinical benefit from the use of direct-acting antivirals for hepatitis C virus in patients with a history of liver cancer.
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