Copay for Some Brand-Name Drugs Significantly Higher than Generic for Medicare Part D Patients

July 7, 2016

Medicare Part D patient copayments for two popular brand-name drugs are 10.5 times higher, when compared to the leading generic therapeutic equivalents, according to a new study in Health Affairs.

Researchers analyzed 2013 costs data for all medications under Medicare Part D, released last year by the Centers for Medicare and Medicaid Services (CMS). The study's findings focused on brand-name drugs, Crestor (rosuvastatin calcium, AstraZeneca), a cholesterol medication, and Nexium (esomeprazole, Pfizer Inc), taken for acid reflux.

Although generic drugs represented approximately 76% of the drugs prescribed through Medicare Part D in 2013, brand-name drugs are often still listed as "preferred" by insurers due to the availability of special rebates.

Previously recorded data determined about half of enrollees, in 2012, received less than $22,500 in income. Due to high brand-name copayments and low incomes, some patients may tend "to choose between food or medications based on their monthly budget," according to researchers.

The top 10 generic drugs in Medicare Part D, based on 2013 claims data, accounted for $4.1 billion in expenses. However, the top 10 most expensive drugs, ranked by spending, were all brand name drugs, accounting for $19.8 billion in spending. Of the top 10 most expensive brand name drugs, Nexium was ranked first at $2.8 billion in spending, and Crestor was third at $2.3 billion.

Furthermore, researchers estimated a combined $870 million in savings for the government, patients, and insurance companies, if the generic equivalent for Nexium, had been prescribed instead. Likewise, the researchers estimated $1.2 billion in savings, if the generic equivalent of Crestor were prescribed instead.

The study's lead author, Nicole Gastala, said that due to advertising, patients frequently choose the brand name, and often do not know the cost of the drug or how expensive the copay will be.


Gastala NM, Wingrove P, Gaglioti A, Petterson S, Bazemore A. Medicare Part D: Patients Bear The Cost Of 'Me Too' Brand-Name Drugs [Published online July 2016]. Health Aff. 2016; 35(7):1237-1240. doi: 10.1377/hlthaff.2016.0146

Bluth, R. Study: Brand-Name Drugs' High Copays Soak Medicare Part D Patients. Kaiser Health News. Published July 6, 2016. Accessed July 7, 2016.




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