By Linda Carroll

(Reuters Health) – If doctors prescribed short-acting medications that must be taken twice a day instead of once-a-day extended-release versions, billions in healthcare costs could be saved, a new study suggests.

Based on Medicare and Medicaid spending between 2012 and 2017, prescriptions for extended-release drugs cost the healthcare system almost $14 billion more than would have been spent on equivalent twice-a-day medications, researchers report in JAMA Network Open.

“It’s not a huge difference in terms of patient convenience, but the cost difference is remarkable,” said coauthor Dr. Ambarish Pandey of the University of Texas Southwestern Medical Center in Dallas.

Pandey and colleagues looked specifically at drugs whose benefits in a twice-a-day version are equivalent to those of the extended-release version. While it’s argued that patients are more likely to stick with their medication schedule if the drug is taken once a day, that hasn’t been proven, Pandey said. “There might be a difference if it was three times a day,” he allowed.

To analyze how much extended-release medications were adding to health-system costs, Pandey’s team reviewed records from the Medicare Part D Prescription data set and the Medicaid Spending and Utilization Data set for 2012 through 2017.

The Medicare database includes medication expenditures for approximately 70% of all beneficiaries of Medicare, the federal health insurance program for people aged 65 and older and the disabled. The Medicaid database contains spending for outpatient drugs by state agencies that administer the federal-state Medicaid insurance program for low-income families.

The researchers winnowed down their list of medications to 20 drugs, which had 37 formulations, 19 of them brand-name and 18 generic.

In 2017, Medicare Part D spent $2.2 billion and Medicaid spent $952 million on extended-release versions of those drugs. The researchers estimate that swapping twice-daily versions for all extended-release formulations that year would have saved Medicare and Medicaid a total of $2.6 billion.

Over the entire 2012-2017 study period, Medicare Part D spent $12 billion on extended-release formulations while Medicaid spent $5.9 billion, and a switch to twice-daily versions would have saved $13.7 billion, they conclude.

The way to fix the problem is for insurers to demand that drug companies reduce extended-release costs to the point where the price is comparable to that of the twice-a-day version, Pandey said.

“If Medicare puts its foot down and says it won’t put the extended-release versions on their formulary unless the price is similar to that of the immediate-release formulations, things will change,” he said.

What’s interesting about this paper is the concept of trying to reduce medication cost by switching drugs rather than trying to get a decrease in price from the pharmaceutical company, said Dr. Walid Gellad, director of the University of Pittsburgh Center for Pharmaceutical Policy and Prescribing.

Gellad commended the authors for focusing on drugs that had a short-acting version with the same therapeutic effects as the extended-release version and for looking only at short-acting drugs that would be taken twice a day as opposed to three or more times a day.

But, Gellad said, that doesn’t mean the drugs are completely comparable. “For example, the diabetes drug metformin is one of the big drivers of savings, but the problem is, a lot of patients get stomach upset with the short-acting form,” he explained.

“Having said that, there are many instances where people could use the short-acting form and wouldn’t be burdened with side effects and would do just as well as with the extended-release form,” Gellad said. “One of the main messages for clinicians is that we should always offer the short-acting form to our patients if they can’t afford the long-acting version.”

SOURCE: JAMA Network Open, online February 28, 2020.