Average Out-of-Pocket Expenses Across Different Drug Categories and Commercial Third-Party Payers

| October 31, 2010 | 0 Comments

by Susan Lenderts, BA, and Amir H. Kalali, MD
Ms. Lenderts is Associate Director, Global Commercial Partnering, Quintiles Commercial, Durham, North Carolina; Dr. Kalali is Vice President, Global Therapeutic Group Leader CNS, Quintiles, Inc; Professor of Psychiatry, University of California, San Diego, California.

Psychiatry (Edgemont) 2010;7(10):12–13


Funding:
There was no funding for the development and writing of this article.

Financial Disclosures:
Ms. Lenderts reports no conflicts of interest to the content of this article. Dr. Kalali has served as an advisor to Merck, Novartis, Pfizer, and Vanda Pharmaceuticals.

Key Words: Psychiatry, ADHD, depression, SSRI, SNRI, atypical, antipsychotic, generic, brand, co-pay, out-of-pocket cost, managed care, payer, commercial third-party

Abstract: In this Trend Watch, we look at retail pharmacy prescriptions for branded and generic attention deficit hyperactivity disorder treatments, atypical antipsychotics, selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors and analyze the average out-of-pocket costs incurred by patients who are covered by commercial third-party prescription plans (i.e., as opposed to patients covered by Medicaid or patients with no prescription coverage). Overall, patient out-of-pocket costs in commercial third-party plans are lower for generic prescriptions than they are for brand prescriptions by at least $19.02. Comparisons across the drug classes reveal that the average co-pay for brands and generics, as well as the difference between brand and generic out-of-pocket costs, differ by drug category.

Introduction

In this article, we examine retail payer data for attention deficit hyperactivity disorder (ADHD) treatments, atypical antipsychotics, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs) to compare average out-of-pocket expenses (i.e., co-pays) incurred by patients covered by commercial third-party prescription drug plans. Within the therapeutic classes, products are classified as branded agents or generic agents.

Methods

We obtained projected, patient-centric payer data from SDI’s Vector One: Payer (VOPA). In addition to traditional projected prescription metrics, VOPA enables us to analyze average out-of-pocket costs per prescription by payer type (e.g., Medicaid, commercial third-party, cash payers). The SDI data warehouse receives 1.6 billion prescription claims per year and includes prescription samples from nearly 37,000 pharmacies in the United States. Individual products within each drug category (ADHD, SSRI, SNRI, Atypical Antipsychotic) were classified into one of the following two groups: branded agents and generic agents. Branded agents that have generic alternatives available in the market were excluded from this analysis.

Results

Figure 1 presents, by drug category, the average out-of-pocket costs (OPCs) per prescription incurred by patients covered by commercial third-party payer plans. Overall, patients dispensed a generic product in our categories of interest paid lower OPCs for generic products than patients dispensed a branded agent. In addition, the analysis revealed the following:

  • Atypical antipsychotics had the highest average OPC among branded agents in our drug categories of interest ($46.40 in July 2010) and SSRIs had the lowest average OPC for brands ($37.20 in July 2010). The difference between the highest and lowest average brand OPCs was almost $10.
  • SSRIs had the lowest average OPC for generic product prescriptions ($8.16 in July 2010) and SNRIs had the highest average OPC for generic product prescriptions ($21.90 in July 2010). The difference between the highest and lowest average generic OPCs was over $10.
  • The largest disparity between average brand OPC and average generic OPC occurred in the atypical antipsychotic class: In July 2010, the average OPC per prescription for branded atypical antipsychotics was $34.27 higher than the average OPC for generics in the class.
  • The smallest difference between average brand OPC and average generic OPC occurred in the SNRI class (difference was $19.02 in July 2010). Of note, the average generic SNRI OPC was the highest among generic products ($21.90 in July 2010).

Tags: , , , , , , , , , , , , ,

Category: Anxiety Disorders, Drug Development, Mood Disorders, Past Articles, Psychiatry, Psychopharmacology, Schizophrenia, Trend Watch

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.