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Medicare Part D has no impact on generics prescribing in long-term care Posted 17/01/2020

A recent observational study [1] in long-term care facilities in the US shows that the Medicare Part D programme has no significant effect on the rate of generic drug prescriptions, contrary to expectations.

Spending on drugs in the US is some of the highest in the world; the nation spent over US$328 billion on prescription drugs in 2016 alone. To curtail costs, the government initiated the Medicare Part D programme to subsidize prescription drug costs for enrolees.

The Part D programme shifts financial responsibility for prescription drugs from consumers to Medicare and therefore may be expected to increase prescriptions for generic drugs, as this would reduce overall federal spending on drugs.

However, as decisions on which drugs to prescribe are made by individual physicians, this may not be the case. To better understand this, a recent study [1] investigated the influence of Medicare Part D on generic drug prescriptions in long-term care facilities, where patients are often unable to direct the course of their treatment or make decisions on medications. This is the first study to explicitly assess the effect of Medicare Part D on physician prescription patterns in long-term care.

The researchers analysed prescription data for three of the most common drug classes in long-term care facilities: atypical anti-psychotics, e.g. Clozaril; proton pump inhibitors (PPIs), e.g. Omeprazole; and statins, e.g. Crestor. The study was based on data between 2004 and 2007.

Surprisingly, the results showed that Medicare Part D had no statistically significant effect on generic drug prescription rate. There was no shift to generic drugs in the anti-psychotic or PPI classes. Although the researchers did find a 20% increase in generic statin prescriptions, the authors say this is mainly due to loss of patent protection for Zocor (simvastatin). These findings are consistent with a previous study that found lower generic drug use among Part D enrolees.

Overall, the authors say that the dynamics of the drug market, and particularly the increased availability of generic versions of popular prescription drugs, played a bigger role in increasing the rate of generic drug prescriptions than Medicare Part D. As such, the researchers say patent policies on prescription medicines should be relaxed and recommend that policymakers and plan providers promote the use of generic drugs among Medicare beneficiaries.

Conflict of interest statement
The authors have no conflicts of interest to disclose.

Editor’s comment
Readers interested to learn more about generic usage in the US are invited to visit www.gabi-journal.net to view the following manuscripts published in GaBI Journal:

Pharmacy chain drives choice among manufacturers of generic drugs in the US Medicare population

A comparison of European and US generic drug markets

Low-cost generic drug programs in the US: implications for payers and researchers

Readers interested in contributing a research or perspective paper to GaBI Journal – an independent, peer reviewed academic journal – please send us your submission here.

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Reference
1. Jung C, Padman R, Anwar S. The impact of Medicare part D prescription drug benefit program on generic drug prescription. Medicine. 2019;98(32):e16646.

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