Utilization and cost of anti-osteoporosis therapy among US Medicare beneficiaries

Arch Osteoporos. 2016 Dec;11(1):28. doi: 10.1007/s11657-016-0283-2. Epub 2016 Aug 30.

Abstract

There is a strong impetus to prevent and treat osteoporosis to prevent fractures. $990 million dollars was spent on anti-osteoporosis drugs in 2013. As we shift our focus on primary prevention of fractures, providers are encouraged to find the most cost-effective anti-osteoporosis therapy for patients.

Purpose: Osteoporosis is a major global problem with osteoporotic fractures posing a potentially avoidable burden on healthcare resources. We studied the utilization and cost of anti-osteoporotic therapy using the 2013 Medicare Part D data.

Methods: Descriptive data were produced from Microsoft Excel and SPSS regarding the anti-osteoporotic drugs of interest.

Results: In total, Medicare and its beneficiaries spent approximately $990 million on anti-osteoporotic therapy in 2013. Despite this cost, only one in two adults with osteoporosis aged 65 and older received a prescription for an anti-osteoporosis drug. $756 million (77 %) was attributable to brand name drugs which accounted for 2,459,931 claims (22 %). Generic dispensing rate varied from 57-86 % (mean 77 ± 6) across the different states in the USA. States that mandate substitution with generic equivalents had a higher generic dispensing rate compared to the states that permit generic substitution (92 vs. 90 %; p < 0.05). After adjusting for claim counts, we found that if the states that permit substitution with generic equivalents showed the same generic dispensing rate of 92 % as the states that mandate such substitution, there is a potential for savings of $7.5 million, approximately 9 % of the total expenditure in these states on oral bisphosphonates alone. Thirty-eight percent of the total prescriptions from orthopedic surgeons were for Forteo® or Prolia® compared to 12.5 % from specialists.

Conclusions: These findings highlight the need for ongoing training for physicians who engage in the care of patients with osteoporosis to manage the disease in a cost-effective manner.

Keywords: Brand name drugs; Cost; Generic drugs; Osteoporosis; Primary care providers; Utilization.

MeSH terms

  • Adult
  • Aged
  • Bone Density Conservation Agents* / economics
  • Bone Density Conservation Agents* / therapeutic use
  • Cost of Illness*
  • Cost-Benefit Analysis
  • Drug Costs
  • Female
  • Humans
  • Male
  • Medicare Part D / statistics & numerical data*
  • Middle Aged
  • Needs Assessment
  • Osteoporosis* / complications
  • Osteoporosis* / drug therapy
  • Osteoporosis* / economics
  • Osteoporosis* / epidemiology
  • Osteoporotic Fractures* / epidemiology
  • Osteoporotic Fractures* / prevention & control
  • United States / epidemiology

Substances

  • Bone Density Conservation Agents