Date of Award

2019

Embargo Period

8-1-2024

Document Type

Dissertation

Degree Name

Doctor of Health Administration

College

College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Daniel Brinton

Third Advisor

Erin R. Weeda

Abstract

Purpose: Multiple Sclerosis (MS) is a chronic condition managed by disease modifying pharmaceutical therapies (DMTs). Health care cost is increasing due to high prescription drug spending. The high cost of branded DMTs highlights the potential value of lower cost generic therapies. Using generic DMTs could reduce the spending in the prescription drug sector. Recently, generic glatiramer acetate (GA) that treats relapsing remitting multiple sclerosis has become available. Appropriate insurer policies and practices are imperative to promote the use and utilization of generics like GA. Notably, no study has specifically evaluated the differences in utilization uptake of branded vs generic GA among the major insurer categories. The purpose of this study is to establish whether insurer type affects the rate of utilization uptake of branded vs generic GA. Methods: Prescription claims data for branded or generic glatiramer acetate for Commercially insured patients, Medicare beneficiaries with supplemental insurance, and Medicaid patients were extracted from Symphony Health Integrated Dataverse® data set from Oct 2014 – Jan 2019. Patient claim cohorts were identified through branded Copaxone® 20 mg or 40 mg, generic Glatopa® 20 mg or 40 mg, and generic Mylan Glatiramer Acetate 20 mg or 40 mg national drug codes. Data was limited to 52 months of claims data inclusive of FDA post-approval of generic glatiramer acetate options. Projected glatiramer acetate utilization rates were estimated using exponential regression modeling. Patient out of pocket costs were captured as pharmacy transactional level insights from the patient’s primary plan pay setting of the initial co-pay amount and additional plan pay from third-party utilization of copay cards subsidizing the prescription. Results: From October 2014 to January 2019, 111,906 patients with multiple sclerosis were prescribed glatiramer acetate by Neurologists (80%) and had 1,624,159 approved dispensed claims primarily through specialty mail (87%) and categorized by payment type as 63.2% Commercial, 25.4% Medicare, and 11.8% Medicaid. The market trend showed a consistent decline in branded glatiramer acetate claims offset by a rapid uptake in generic glatiramer acetate with its initial market entry but remained relatively flat until launch of an additional generic market entrant. Generic market share has continued to grow reaching an approximate 30% share of claims. Over the 52 months brand glatiramer acetate utilization has declined more than half at 56%, while generic claim volume has grown 155% over the past 16 months. Among the payer types, Medicare has observed the greatest brand decline at 70% and the second highest generic utilization uptake at a 28% share. Commercial insurers have the greatest category claim volume and greatest generic growth to a 26% share, while the brand has declined by 44%. Medicaid has had the lowest utilization volume and the greatest ratio of generic utilization among insurers at 45%. Patient out of pocket costs are highest with branded use across all insurer types, while Medicaid has the lowest patient out-of-pocket costs. Across all payment types, generics offer approximately a 20% discount to the brand in patient out of pocket costs. Conclusion: The study revealed that generic glatiramer acetate adoption or utilization has been slow among insurers but increasing over the past sixteen months with additional generic GA entrants and increased price competition. The greatest trend in generic utilization is occurring within the Commercial channel followed by Medicare and Medicaid, which has had the lowest growth trend. The results indicate that barriers to generic glatiramer acetate may vary by insurer and influenced by prescriber or patient choice. Generic uptake is projected to increase across all insurer types reflective of trends during 2019 open enrollment and healthcare benefit design change associated with a new health insurance cycle. Lower patient out-of-pocket costs and generic preferred formulary positioning will influence utilization rates, especially in beneficiaries or enrollees with the greatest financial cost shift risk.

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