Researchers compared average out-of-pocket patient costs as well as
spending by Medicare, the U.S. health insurance program for people
65 and older, for several commonly prescribed topical
corticosteroids that have been used for decades to treat a wide
variety of inflammatory skin conditions.
Medicare Part D, the drug benefit program, spent $2.3 billion on
topical steroids between 2011 and 2015, the study found. During that
period, spending surged 227 percent while the number of
prescriptions increased just 37 percent.
If doctors had prescribed the cheapest version when a variety of
similarly effective options were available, Medicare could have
saved $944.8 million, the researchers calculate.
Patients could have saved a lot too; seniors’ annual out-of-pocket
spending for topical steroids grew from $41.4 million to $101.8
million, 146 percent, during the study period.
“Patients often have difficulty paying for their medications and
many patients on Medicare are retired and on fixed incomes,” said
senior study author Dr. Arash Mostaghimi, a dermatology researcher
at Harvard Medical School and Brigham and Women’s Hospital in
“Paying extra for their medications may mean going without other
medications or sometimes food,” Mostaghimi said by email.
Generics accounted for almost 98 percent of total spending on
topical steroids during the study period, the researchers report in
In theory, generic drugs are supposed to come on the market after
brand-name versions lose U.S. patent protection and help lower
prices by increasing competition. The study of topical steroid
costs, however, offers one look at a much more complex and confusing
For the study, researchers examined costs for drugs grouped based on
potency, or how much medication is blended into the ointments and
creams. They sorted drugs into five classes, with one being the most
potent and five being the weakest potency.
Costs grew at the slowest rate, 23 percent, for the weakest
steroids, the study found. By contrast, costs rose the most, 604
percent overall, for the most potent group of steroids.
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Within that group of most potent steroids, the steepest increase in
average user costs was for clobetasol propionate (Temovate), which
is used to treat itching and inflammation from skin issues caused by
allergic reactions, eczema and psoriasis. During the study, user
costs for this drug climbed by more than 605 percent.
Limitations of the study include the lack of data on certain drug
manufacturer rebates that might help lower costs, the authors note.
Researchers also didn’t know if doctors had certain clinical reasons
for choosing specific versions of similar medicines.
Still, the study illustrates something doctors already see all the
time: that these costs often take a toll on patients, said Dr.
Joslyn Kirby, author of an accompanying editorial and a dermatology
researcher at Penn State Hershey Medical Center.
One challenge for doctors is that they can’t always see what
different steroids of similar potency cost when they prescribe the
drugs, because that’s not in electronic medical records, Kirby said
“I ask my patients to contact me and let me know if the medication I
prescribed during the appointment is too expensive when they go to
the pharmacy,” Kirby added. “I need my patients to know that it’s ok
to tell me that something is too expensive, because I can work with
our staff to find an alternative or a solution.”
SOURCE: http://bit.ly/2pVfrPy and http://bit.ly/2oV5ams JAMA
Dermatology, online April 28, 2017.
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