Otsuka's Abilify leads Medicaid spending, report finds, with Gilead's hep C meds close behind

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Amid a period of intense drug pricing scrutiny, data are out on the costliest drugs to Medicaid, with some of pharma's biggest names among the highest-ranking brands. It's a tale of the Medicaid population--more likely to be treated for hep C and HIV, plus mental health disorders--and the sometimes pricey drugs they're prescribed.

A new report by the Kaiser Commission on Medicaid and the Uninsured shows that, of the top 19 costliest medicines to Medicaid, all cost more per prescription than at least three-fourths of other meds. The program put up $27.4 billion in outpatient drug spending in 2014.

Sitting at the top was Otsuka's antipsychotic drug Abilify, priced higher per prescription than 90% of all drugs used by Medicaid patients, and among the most-prescribed meds in the program. The report covers January 2014 to June 2016, so timing may have played a factor in the results; Abilify lost patent protection in mid-2015 and Otsuka raised the prices as the med neared the patent cliff, "a strategy often seen before a brand drug’s patent expires," Kaiser Commission points out.

While Abilify's per-prescription cost and prescription frequency propelled it to the top of the list, its price wasn't nearly as high as some drugs covered by Medicaid. It failed to make Kaiser Commission's top 50 list of priciest drugs on a per-prescription basis.

Behind Abilify in total Medicaid spending were Gilead Sciences’ ($GILD) hepatitis C treatment Sovaldi--costing more than 99% of other meds while prescribed more frequently than 90%. Rounding out the top were Shire’s ($SHPG) ADHD med Vyvanse, Gilead’s hep C combo Harvoni and HIV fighter Truvada, and Sanofi’s ($SNY) basal insulin for diabetics, Lantus.

Many of the drugs on the most-costly list treat behavioral health conditions for which Medicaid is a major provider, Kaiser Commission pointed out. Medicaid provides access to more than 70 million people.

On a per-prescription basis, Novo Nordisk’s ($NVO) rare disease drug for hemophilia, NovoSeven RT, topped the list at a price of $58,843 before rebates; fellow hemophilia treatment Koate-DVI followed closely behind at $57,162. Many of the drugs at the top of the per-prescription cost list are those for serious health conditions such as hemophilia, multiple sclerosis or rare infant diseases. Baxalta ($BXLT) hemophilia med Feiba landed at third at a per-prescription cost of $48,366 before rebates and Sigma-Tau's rare disease med Adagen, costing $44,551, was fourth.

Mallinckrodt's ($MNK) H.P Acthar Gel--which has had a history of pricing controversy dating back to previous owner Questcor--ended up near the top of the list at No. 5, costing Medicaid $43,877 before rebates.

Sovaldi and Harvoni, with their infamous list prices of $84,000 and $94,500 respectively, ranked outside of the top 15 in per-prescription costs to Medicaid. Harvoni ended up at No. 16 and Sovaldi at No. 24, with their per-prescription costs to the program at $28,977 and $26,612 before rebates, according to the report.

The most frequently prescribed drug over the period was hydrocodone-acetaminophen, information that could play a role in an effort by federal authorities to rein in opioid prescriptions and tackle an epidemic of addiction.

Only a handful of generics made the top 50 costliest meds list. Ninety-four percent of the top 50 were brands, while brands accounted for just 45% of all Medicaid drugs.

- here's the report

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