Association between changes in prices and out‐of‐pocket costs for brand‐name clinician‐administered drugs

Abstract

AbstractObjectiveTo determine whether annual changes in prices for clinician‐administered drugs are associated with changes in patient out‐of‐pocket costs.Data Sources and Study SettingNational commercial claims database, 2009 to 2018.Study DesignIn a serial, cross‐sectional study, we calculated the annual percent change in manufacturer list prices and net prices after rebates. We used two‐part generalized linear models to assess the relationship between annual changes in price with (1) the percentage of individuals incurring any out‐of‐pocket costs and (2) the percent change in median non‐zero out‐of‐pocket costs.Data Collection/Extraction MethodsWe created annual cohorts of privately insured individuals who used one of 52 brand‐name clinician‐administered drugs.Principal FindingsList prices increased 4.4%/yr (interquartile range [IQR], 1.1% to 6.0%) and net prices 3.3%/yr (IQR, 0.3% to 5.5%). The median percentage of patients with any out‐of‐pocket costs increased from 38% in 2009 to 48% in 2018, and median non‐zero annual out‐of‐pocket costs increased by 9.6%/yr (IQR, 4.1% to 15.4%). There was no association between changes in prices and out‐of‐pocket costs for individual drugs.ConclusionsFrom 2009 to 2018, prices and out‐of‐pocket costs for brand‐name clinician‐administered drugs increased, but these were not directly related for individual drugs. This may be due to changes to insurance benefit design and private insurer drug reimbursement rates.