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Pulmonary Hypertension
Yasmeen WermersDr. Jalpa Doshi PhD
Agenda• What is pulmonary hypertension?• Pulmonary hypertension groups• Epidemiology • Medicare• PAH drugs• Research application• Acknowledgement • Q&A
What is Pulmonary Hypertension
• Increase in blood pressure in pulmonary circulation• Affects arteries in the lungs and right side of heart• Treatments exist, but no cure
• Often fatal • Trigger other cardio and pulmonary issues
PAH Groups
• PAH is classified in 5 groups• Depend on trigger• Group 1 is the most common • Often fatal • Trigger other cardio and pulmonary issues
PAH Groups• PAH is classified in 5 groups• Depend on trigger• Group 1
• Most common• 46% of PAH patients diagnosed • Genetic
• Previous conditions:• Connective tissue diseases• HIV • Heart disease• Street drug abuse
Epidemiology • Prevalence of 15-50 cases per million individuals• 20,000 to 200,000 cases per year US• Common among women, and african americans• Among people aged 50 or older• Female to male is 3.9• Estimates for PAH
• 51 (384-519) per million individuals for Medicare• Average cost $98,243 per year
http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_pulmonary_hypertension.htm
• Must be >65 yrs
• disabled beneficiaries younger than age 65
• Prescription drug coverage offered by private plans
• Drugs classified as Part B or D
• Part B: Drugs administered by physician or medical professional
• Part D: Drugs that can be self administered without supervision
Medicare
Beneficiary Pay 25%Plan Pays 75%
Initial Coverage Period
Individual Pays
Medicare Pays
$320 Deductible
Hole
$ 2,906 total cost
Beneficiary Pay: 65% Generic
45% Brand names
Catastrophic Coverage period
Beneficiary Pay:5% of costs
2.65% Generics6.60% Brand Name
Hold Ends$4,700 Annual OOP threshold
Medicare Part D
• OOP Costs: Out of pocket cost • LIS patients
• Receive extra help
• Dual eligible
• Medicare and Medicaid coverage
• $2.65 for each generic
• $6.60 for each brand-name
• Non LIS • Medicare coverage only
Brand name Generic name Manufacturer Routes Medicare
coverage
FDA approval date for
PAH1 Flolan epoprostenol IV GlaxoSmithKline IV Part B 1995 Sept
2 Veletri room temperature stable epoprostenol Actelion IV infusion Part B 1995
3 Revatio sildenafil Pfizer Oral Part D 1998
4 Tracleer bosentan Actelion Oral Part D 2001 Nov
5 Remodulin treprostinil United Therapeutics Corp.
SubQ or IV Part D 2002 May
6 Ventavis iloprost (only availible in the USA) CoTherix, Inc Inhaled Part D/B 2004 Dec
7 Letairis ambrisentan Gilead Oral Part D 2007 June
8 Adcirca tadalafil Eli Lily Oral Part D 2009 May
9 Tyvaso treprostinil inhaledUnited Therapeutics Corporation
Oral Inhalation Part B 2009 Jul
10 Opsumit macitentan Acetlion Oral Part D 2013 Oct
11 Adempas riociguat Bayer Healthcare Oral Part D 2013 Oct
12 Orenitram treprostinilUnited Therapeutics Corporation
Oral Part D 2013 Dec
Part D sildenafil
2012overall LIS non-LIS
number of users 5325 3844 1359
mean number of 30-day Part D claims 7 (4) 7 (4) 6 (4)
mean cost per 30-day claim $1895 ($1039) $1943 (1091) $1771 (866)
mean OOP cost per 30-day claim $89 (191) $2 (3) $337 (242)
mean cost per user $13653 (12612)
$14682 (13118) $11172 (10833)
mean OOP cost per user $407 (901) $8 (9) $1548 (1190)
sildenafil
Part D ambrisentan
2012overall LIS non-LIS
number of users 2418 1192 1141
mean number of 30-day Part D claims 9 (4) 8 (4) 9 (4)
mean cost per 30-day claim $6243 (385) $6239 (377) $6251 (396)
mean OOP cost per 30-day claim $343 (504) $1 (1) $701 (522)
mean cost per user $53585 (26552)
$53031 (26559) $54664 (26399)
mean OOP cost per user $2291 (2655) $4 (4) $4728 (1821)
ambrisentan
Part D bosentan
2012overall LIS non-LIS
number of users 3654 1749 1793
mean number of 30-day Part D claims 10 (4) 10 (4) 10 (3)
mean cost per 30-day claim $6263 (486) $6252 (578) $6278 (379)
mean OOP cost per 30-day claim $302 (397) $1 (6) $605 (372)
mean cost per user $61448 (22668)
$60207 (23123) $62875 (22195)
mean OOP cost per user $2603 (2812) $7 (62) $5212 (1592)
bosentan
Part D tadalafil
2012overall LIS non-LIS
number of users 3421 1641 1672
mean number of 30-day Part D claims 8 (4) 8 (4) 8 (4)
mean cost per 30-day claim $1333 (260) $1324 (269) $1343 (249)
mean OOP cost per 30-day claim $130 (178) $1 (2) $259 (177)
mean cost per user $10461 (6194) $10446 (6116) $10576 (6274)
mean OOP cost per user $837 (1112) $9 (9) $1671 (1062)
tadalafil
Part B epoprostenol
2012overall LIS non-LIS
number of users 296 180 110
mean number of claims 11 (4) 11 (3) 11 (4)
mean cost per claim $3475 (2029) $3656 (2275) $3225 (1559)
mean OOP cost per claim $695 (406) $731 (455) $646 (312)
mean cost per user $40190 (27638)
$41622 (29764) $38722 (24189)
mean OOP cost per user $8040 (5527) $8326 (5953) $7748 (4836)
epoprostenol
Part B iloprost
2012overall LIS non-LIS
number of users 333 175 146
mean number of claims 8 (5) 8 (5) 8 (5)
mean cost per claim $11316 (3113) $11225 (3109) $11458 (3115)
mean OOP cost per claim $2266 (624) $2249 (623) $2293 (623)
mean cost per user $89927 (53242)
$87093 (52051) $93686 (54944)
mean OOP cost per user $18003 (10656)
$17440 (10417) $18749 (10996)
iloprost
Part Btreprostinil
2012overall LIS non-LIS
number of users 1198 686 478
mean number of claims 9 (4) 9 (4) 9 (4)
mean cost per claim $13693 (6428) $14008 (6918) $13264 (5668)
mean OOP cost per claim $2820 (1703) $2922 (1929) $2684 (1342)
mean cost per user $129641 (91047)
$134534 (97860)
$123022 (78694)
mean OOP cost per user $26164 (18595)
$27269 (20184) $24675 (15733)
treprostinil
Application of research
• Understand the effect of cost sharing on adherence and outcomes
• Study drug adherence and hospitalization
• Comparative effectiveness and cost-effectiveness studies of the various PH drug treatments
• Study the value of innovation
SUMR Reflection • Gained new skills
• Research skills• SAS
• Better understanding • Medicare• Part D and B• Drug Pricing
• Gained interest• Price elasticity• Patient/Provider behavioral from an Economic perspective
Acknowledgements • Thank you, team
• Dr. Doshi• Dr. Tianyan Hu • Dr. Pengxiang Li• Vrushabh Ladage • Rish Kumar• Kevin Huang
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