Gilead hepatitis C pill was biggest 2015 drug cost for Medicare, Medicaid

The latest dive into Medicaid and Medicare prescription drug data shows that the federal health care programs spent more on the Harvoni hepatitis C treatment last year than any other medicine.

Medicare Part D spent slightly more than $7 billion on the Gilead Sciences product, while Medicaid coughed up nearly $2.2 billion for the drug, according to data released today by the Centers for Medicare and Medicaid Services.

The agency released its latest dashboard, an interactive tool that chose a few dozen drugs for which spending or unit costs rose by notable amounts, as well as those brand and generic medicines that contributed to large program spending overall. There were 40 drugs chosen from both Medicare Part D and Part B, and 70 drugs from Medicaid. The data does not include rebates, but some older rebate information for Medicare is provided.

There is a wealth of information, but here are some of the most interesting findings:

Let’s start with Medicare Part D:

Besides Harvoni, the five drugs with highest total spending in 2015 were Spiriva and Advair Diskus treatments for chronic obstructive pulmonary disease, which are sold by Boehringer Ingelheim and GlaxoSmithKline, respectively; Crestor, the cholesterol fighter from AstraZeneca (for which generics have since become available), and Lantus insulin sold by Sanofi. The Part D program spent $2 billion or more on each of these drugs, with more than $4 billion spent on Lantus, and nearly $3 billion on Crestor.

Gleevec, the leukemia treatment sold by Novartis, registered the highest unit cost at $81,152 per person and accounted for $1.2 billion in Part D spending. And Glumetza, the diabetes tablet sold by Valeant Pharmaceuticals had the highest average increase in unit cost at 381 percent. Consequently, spending for that medicine reached $153 million, up from $34.3 million. Increases in unit costs exceeded 275 percent for three other drugs.

Overall, the dashboard identified 119 drugs for which spending exceeded $250 million and these accounted for 64 percent of Part D spending. There were 335 drugs for which per-beneficiary spending was greater than $10,000, up from 267 drugs in 2014. And there were 538 drugs with unit cost increases of more than 25 percent, down slightly from 540 two years ago. All of the Part D drugs included in the dashboard accounted for 34 percent of program spending.

One thing to note: the data do not include rebate information that Medicare may receive from drug makers, because federal law restricts the release of this information, a CMS blog post noted.

For the first time, though, CMS did provide a summary of rebate data, but for 2014, not 2015. In total, more than $16 billion in manufacturer rebates for brand-name drugs were collected by Part D plans in 2014 for an average rebate of 17.5 percent. Among the Part D brand name drugs listed in the 2014 dashboard, the average manufacturer rebate was 17.8 percent, and 22 of these drugs accounted for a total of $6.6 billion in rebates.

Moving over to Medicare Part B:

The program, which covers injectable and infused medicines, spent $1.8 billion on Regeneron Pharmaceuticals’ Eylea treatment for macular degeneration, more than any other drug. Rounding out the top five were Lucentis, a treatment for macular degeneration sold by Roche; the Remicade rheumatoid arthritis drug sold by Johnson & Johnson; Amgen’s Neulasta, which is used to generate white blood cells after chemotherapy; Rituxan, a non-Hodgkin’s lymphoma marketed by Biogen and Genentech. Each contributed more than $1 billion in spending for the Part B program.

Meanwhile, the Tysabri multiple sclerosis medicine sold by Biogen cost $39,767 per beneficiary and caused Part B to spend nearly $289 million. And the drug with the largest increase in unit cost was mitomycin, a generic chemotherapy treatment, which jumped 163 percent. There were six medicines for which unit costs increased more than 20 percent.

Overall, the dashboard identified 23 drugs for which Part D spent more than $250 million and accounted for 60 percent of program spending. There were also 125 drugs with unit cost increases exceeding 25 percent, up from 96 drugs in 2014. And there were 118 drugs with spending per beneficiary that exceeded $10,000, up from 107 drugs two years ago. All of the Part B drugs included in the dashboard accounted for 69 percent of program spending.

And then there’s Medicaid:

After Harvoni, the drugs on which Medicaid spent the most were the Abilify anti-psychotic sold by Otsuka Pharmaceutical; the Humira rheumatoid arthritis sold by AbbVie; the Lantus insulin marketed by Novo Nordisk, the Vyvanse ADHD pill sold by Shire. In 2014, Medicaid spent more on Abilify than any other drug, but it was eclipsed for two reasons – generic versions became available last year. Consequently, spending on Abilify declined to $2 billion from $2.1 billion. Spending for Lantus was $1.4 billion and spending for Vyvanse and Humira/Humira pen was approximately $800 million each.

Then there are the top five drugs with the largest increases in average cost per unit from 2014 to 2015. Leading the pack was the Ativan anti-anxiety pill, which had the largest increase in cost per unit at 1,264 percent and a spending increase from $1.7 million to $5.3 million. All five of these drugs had increases in cost per unit of more than 400 percent.

At No. 2 was Daraprim, the life-saving anti-infective sold by Turing Pharmaceuticals. When the company was run by Martin Shkreli, Turing bought the drug and quickly jacked up the price by about 5,000 percent, causing a national sensation. Daraprim’s cost per unit rose 864 percent.

There were five other drugs with unit costs increases of more than 300 percent. In total, Medicaid spending on these 20 drugs with unit cost increases more than doubled from $146 million in 2014 to $486 million in 2015. Of the 20 drugs with the highest per-unit cost increases, nine were generics. Those products had price increases ranging from 140 percent to nearly 500 percent between 2014 and 2015.

Overall, the dashboard identified 155 drugs for which more than $75 million was spent and 578 medicines where the average spending per prescription was more than $1,000. There were also 1,254 medicines for which unit costs rose more than 25 percent. And the Medicaid drugs included in the dashboard accounted for 41 percent of outpatient spending last year.

And if you were wondering why EpiPen wasn’t mentioned, CMS explained that it does not appear in the top 20 Medicaid drugs for which prices or spending increased because the price hikes taken by Mylan Pharmaceuticals occurred prior to this year. Nonetheless, the agency said its data shows that Medicare and Medicaid spending on EpiPen rose by more than 500 percent from 2011 to 2015.