5 Costliest Drugs Per Medicare Part D Beneficiary

Pharmacists should familiarize themselves with how much each prescription cost the US government per patient last year.

Medicare is the biggest purchaser of prescription drugs in the United States, and

the US Centers for Medicare and Medicaid Services (CMS) recently launched a dashboard aimed at promoting transparency in government drug spending.

The interactive dashboard includes 80 prescription drugs with an intention to give all pharmacy stakeholders information on each drug, including a cost trend analysis, brand names, generic names, and manufacturer details.

The 80 drugs included represent 33% of all Medicare Part D spending.

Here are the top 5 costliest drugs per Medicare Part D beneficiary, according to CMS 2014 data on total annual spending per user:

1. Sofosbuvir (Sovaldi)—$94,056

It should come as no surprise that sofosbuvir, a hepatitis C virus (HCV) treatment, tops the list of the most expensive drugs per patient covered by Medicare Part D. Sovaldi and other HCV drugs have been the subject of many high-profile debates since approval in 2013.

Considering the high cost associated with sofosbuvir and other chronic HCV drugs, pharmacists should rethink their formula for determining the drugs’ worth. The drug is excluded from both Express Scripts’ and CVS Caremark’s 2016 formularies.

Tom Frank, PharmD, BCPS, director of research and education at University of Arkansas Medical Sciences Area Health Education Center, told Pharmacy Times in a previous interview that although Sovaldi “might appear to be expensive in terms of…the health-system budget, [these HCV drugs] may have a very decent value because the patient is either not on inpatient status, or they’re with a particular treatment that takes a chronic condition and causes it to go away.”

The CMS Medicare Drug Spending dashboard shows that 33,033 beneficiaries received the drug in 2014 despite the high cost to the program.

2. Bexarotene (Targretin)—$88,689

The oral oncology agent bexarotene holds the second spot on the list of highest total annual spending per Medicare Part D beneficiary, even though it was only provided to 829 beneficiaries in 2014.

Along with many other drugs for skin problems, bexarotene has been steadily increasing in price over the past few years. The drug’s price increased 18-fold over the past 6 years, with an annual change in average cost increase per unit of 123% in just the last year.

3. Bosentan (Tracleer)—$70,122

Bosentan is indicated to treat pulmonary arterial hypertension, and in 2014, it was provided to 5765 total Medicare Part D beneficiaries.

Due to its hepatotoxicity and teratogenicity risk, the drug is only available through a restricted access program. Monthly monitoring is mandatory, and the drug is contraindicated in pregnancy.

4. Imatinib Mesylate (Gleevec)—$69,213

Gleevec was prescribed to 14,388 Medicare Part D beneficiaries in 2014. This specialty drug is used to treat chronic myeloid leukemia.

Total spending for imatinib mesylate increased 28% between 2013 and 2014.

5. Simeprevir Sodium (Olysio)—$65,891

Olysio is an HCV treatment that was prescribed to 12,646 Medicare Part D patients in 2014.

It is excluded from the Express Scripts 2016 formulary in favor of the pharmacy benefits manager’s exclusive HCV treatment option, AbbVie’s Viekira Pak.

Olysio is approved for use in conjunction with Sovaldi, but manufacturer Johnson & Johnson recently submitted a request to the FDA for a label update to permit its use as a standalone treatment.