Dive Brief:
- Branded fixed-dose combinations could be costing Medicare nearly $1 billion a year compared to buying the component generic drugs separately, according to a study by researchers from Brigham and Women's Hospital and Harvard Medical School published Tuesday by JAMA.
- The study compared purchasing 29 branded combination products with the costs for the same constituent generic products at the same or different doses, and similar generic medications in the same therapeutic class. All told, buying the component drugs separately would've cost $925 million less in 2016.
- "For the 10 most costly combination products … the listed Medicare spending could have been an estimated $2.7 billion lower between 2011 and 2016 if the generic constituents had been prescribed," according to the researchers.
Dive Insight:
There are a number of different sides to the findings reported in JAMA.
Amid rising costs, moving patients from pricier brand-name combinations to generic versions of the same constituent drugs could help lower Medicare's bill. While $925 million is a fraction of the $174 billion Medicare spent in 2016 on prescription drugs, more cost-conscious prescribing could still help blunt steady increases in spending.
From a patient's perspective, however, fixed-dose combinations can provide better convenience, particularly for older people or those on complex regimens involving many tablets. Prescribing a combination pill can potentially reduce dosing mistakes and boost compliance.
But the study authors suggest that might not be such a open-and-shut case. "A clear connection between combination products, improved adherence, and improved clinical outcomes has not been solidly established," the researchers write.
In contrast, increased co-payments — like the ones that might be required for branded drug combinations — have been shown to "reduce adherence and worsen clinical outcomes," they continue.
Switching patients to similar generic constituent drugs may also mean using older drugs with different side effects, and there may be medical reasons why certain medicines can't be prescribed.
For biopharma companies, fixed-dose combinations can be a useful way to extend a product's lifecycle just as patent life for one component comes to an end. Separate research cited by the recent JAMA study shows the number of combinations containing drugs already on the market has increased from about one approval per year in the 1980s to seven per year between 2010 and 2012 — suggesting the approach may becoming more common.