Medicaid and Medicare Part B spending on immunomodulators and biosimilars

Abstract

Introduction

Prices for immunomodulators used in dermatological conditions are rising in the United States. While Medicare Part-D solely covers medication costs, Medicare Part-B covers outpatient infusion and injection costs given by medical professionals. We aim to analyze recent trends in Medicare Part-B spending on immunomodulators and their biosimilars used in the treatment of common chronic inflammatory dermatoses.

Methods

The 2012–2018 Medicare Part-B spending data on immunomodulators commonly used for dermatologic conditions were extracted from the Centers for Medicare and Medicaid Services database. Inflation was adjusted to reflect 2012-dollar amounts using the Consumer Price Index.

Results

Medicare Part-B spending has increased by 27.5% from 2012 to 2018 ($2.5B, $3.2B). Average annual total spending (AATS) is greatest for rituximab ($1,522,757,520), and average annual spending per maintenance dose (AASPMD) is greatest for ustekinumab-90 mg ($12,976). The percent change in AASPMD increased for all immunomodulators with Etanercept-50 mg having the greatest percent change (+64.6%, +$285.70). Infliximab had a greater AATS and AASPMD than its biosimilars.

Discussion

Medicare Part-B spending is often overlooked but plays a big role in federal healthcare spending. Exploring the strategic use of less expensive biosimilars could help mitigate spending.

Keywords:

• Medicaid
• Medicare
• Part-B
• immunomodulators

Disclosure statement

VYS is on the board of directors for the Hidradenitis Suppurativa Foundation (HSF), a stock shareholder of Learn Health, and has served as an advisor, investigator and/or speaker for Sanofi Genzyme, Regeneron, AbbVie, Burt’s Bees, Dermira, Eli Lilly, Novartis, Pfizer, Galderma, Leo Pharma, SUN Pharma, Menlo Therapeutics, GpSkin, and Skin Actives Scientific. JLH has served as an advisor for Novartis.