Professor of Pharmacoepidemiology and Pharmacoeconomics University of Cincinnati College of Pharmacy Cincinnati, United States
Background: Obesity is nearly impacted 100 million adults in the United States (2019). Anti-obesity medications (AOMs) provide patients with a multitude of benefits and can prevent certain diseases. Several AOMs have been approved and entered the market since 2012. However, general utilization, pricing, and spending trends of AOMs have not been analyzed yet in Medicaid.
Objectives: This study looked at trends in the pricing, spending, and use of all the AOMs that are offered to the US Medicaid population.
Methods: We obtained information on AOMs for the years 1999 through 2021 from the Centers for Medicare & Medicaid Services using national summary files for outpatient drug utilization and spending. We conducted a retrospective drug utilization study to examine the annual trends of the number of prescriptions, reimbursement expenditures, and the prices of AOMs. The study drugs included (Xenical® - Alli® - Qsymia® - Contrave®, and Saxenda®). Data were analyzed annually and categorized by total prescriptions (utilization), total reimbursement (spending), and cost per prescription as the proxy for each drug's price.
Results: After the FDA approved Qsymia in 2012, the overall number of AOM prescriptions increased. In 2017, prescriptions peaked, after which they began to fall. All of the investigated drugs experienced a sharp decline in prescriptions in 2020, followed by an upward trend in 2021. After they were introduced to the market, the reimbursements for the drugs Qsymia-Contrave-Saxenda started to increase gradually. The annual per-prescription spending on AOMs by Medicaid for the Xenical dramatically rose in 2010 and dropped in 2014 after introducing Qsymia and Contrave to the market; then, it continued the uprising trend. Qsymia and Contrave prices remain sustained over the study time except for 2020, when the cost increased for all studied medications. Saxenda's price dropped in 2018 before it took the rising trend.
Conclusions: Since the new AOMs entered the market in 2012, Medicaid spending has grown significantly. The advantages that these treatments offer might justify the price. Future cohort studies with longitudinal data are required to investigate and further analyze the clinical results and cost-effectiveness of the AOMs.
