Utilization Trends In Platelet Adenosine Diphosphate P2Y12 Receptor Inhibitor and Cost Among Medicare Beneficiaries

Area of Science:

• Pharmacoeconomics
• Cardiovascular Medicine
• Health Services Research

Background:

• Recent acute coronary syndrome (ACS) guidelines recommend newer P2Y12 inhibitors like prasugrel and ticagrelor over clopidogrel.
• Despite guidelines, clopidogrel remains the most frequently prescribed P2Y12 inhibitor in clinical practice.

Purpose of the Study:

• To analyze the utilization and cost trends of P2Y12 inhibitors among Medicare beneficiaries from 2011 to 2018.
• To identify factors influencing P2Y12 inhibitor prescribing patterns and associated expenditures.

Main Methods:

• Utilized Medicare Part D Prescription Drug Data Event set for the years 2011-2018.
• Analyzed beneficiary numbers, prescription frequencies, and total costs for various P2Y12 inhibitors.

Main Results:

• Medicare Part D beneficiaries using P2Y12 inhibitors increased by 34.8% (2.45M to 3.31M) from 2011-2018.
• Total P2Y12 inhibitor costs decreased by 80.4% ($3.72B to $0.72B), largely due to generic clopidogrel availability.
• Clopidogrel usage exceeded 90% of beneficiaries (2013-2018), while newer agents like ticagrelor (Brilinta) and prasugrel (Effient) saw increased utilization and disproportionately high costs.
• Significant expenditure on brand-name clopidogrel (Plavix) and prasugrel (Effient) persisted.

Conclusions:

• Generic clopidogrel has substantially reduced overall P2Y12 inhibitor costs for Medicare beneficiaries.
• Despite guideline recommendations, clopidogrel dominates P2Y12 inhibitor use.
• Increased use of newer, brand-name P2Y12 inhibitors contributes significantly to drug expenditure; earlier generic transitions could lower costs and improve adherence.