OBJECTIVE Billions of public dollars are spent each year on biologic disease-modifying antirheumatic drugs (DMARDs), but the drivers of recent increases in biologic DMARD spending are unclear. This study was undertaken to characterize changes in total spending and unit prices for biologic DMARDs in Medicare and Medicaid programs and quantified the major sources of these spending increases. METHODS We accessed drug spending data from years 2012-2016, covering all Medicare Part B (fee-for-service), Medicare Part D, and Medicaid enrollees. After calculating 5-year changes in total spending and unit prices for each biologic DMARD as well as in aggregate, we performed standard decomposition analyses to isolate 4 sources of spending growth: drug prices, uptake (number of recipients), treatment intensity (mean number of doses per claim), and treatment duration (annual number of claims per recipient), both excluding and including time-varying rebates. RESULTS From 2012 to 2016, annual spending on public-payer claims for the 10 biologic DMARDs included in this study more than doubled ($3.8 billion to $8.6 billion), with median drug price increases of 51% in Medicare Part D (mean 54%) and 8% in Medicare Part B (mean 21%). With adjustment for general inflation, unit price increases alone accounted for 57% of the 5-year, $3.0 billion spending increase in Part D, while 37% of the spending increase was from increased uptake. Accounting for time-varying rebates, prices were still responsible for 54% of increased spending. Unit prices and spending were lower under Medicaid than under Medicare Part D, though temporal trends and contributors were similar. CONCLUSION Postmarket drug price changes alone account for the majority of the recent spending growth in biologic DMARDs. Policy interventions targeting price increases, particularly those under Medicare Part D plans, may help mitigate financial burdens for public payers and biologic DMARD recipients.

中文翻译：

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Medicare和Medicaid中生物抗风湿药的支出和价格趋势的分解分析。

目标每年有数十亿美元的公共资金用于改善生物疾病的抗风湿药（DMARD），但目前尚不清楚生物DMARD支出最近增加的驱动因素。进行这项研究的目的是描述医疗保险和医疗补助计划中生物DMARD的总支出和单价的变化，并量化这些支出增长的主要来源。方法我们访问了2012年至2016年的药物支出数据，涵盖了所有Medicare B部分（服务费），Medicare D部分和Medicaid参保者。在计算出每种生物DMARD以及总的DM的总支出和单价的5年变化之后，我们进行了标准分解分析，以分离出4种支出增长来源：药物价格，吸收（接受者数量），治疗强度（平均数）每个索赔的剂量），和治疗持续时间（每位接收者每年的索赔数量），不包括并包括随时间变化的回扣。结果从2012年到2016年，这项研究中包括的10种生物DMARD的年度公共支付方索赔支出翻了一番多（38亿美元至86亿美元），Medicare D部分的药物价格中位数增长了51％（平均54 ％）和Medicare B部分的8％（平均21％）。调整了总体通货膨胀后，仅单价上涨就占了5年期的57％，D部分的支出增加了30亿美元，而支出增长的37％来自于增加的使用量。考虑到随时间变化的回扣，价格仍占增加支出的54％。尽管时间趋势和贡献者相似，但医疗补助计划下的单价和支出低于医疗保险D部分下的单价和支出。结论仅上市后药品价格的变化就占了生物DMARDs最近支出增长的大部分。针对价格上涨的政策干预措施，尤其是在Medicare D部分计划下的措施，可能有助于减轻公共付款者和DMARD生物接收者的经济负担。