Nuedexta is a good example. Medicare spent $12.30 per pill for Nuedexta in 2016, according to a recent study published in JAMA. And 50,402 Medicare beneficiaries filled prescriptions for that medication, which is used for patients with dementia.
Nuedexta combines dextromethorphan (also available as an over-the-counter cough suppressant) and a 10 mg dose of quinidine, which slows the metabolism of dextromethorphan. The lowest dose of quinidine available in the United States is 200 mg, and it goes for 26 cents per pill. If the 10 mg dose were available for the Medicare beneficiaries and prescribed along with dextromethorphan, it could have reduced spending by $189.1 million in 2016.
That’s just one of the findings of the study, published in August. Its other conclusion could not help but generate headlines: Medicare could have saved almost a billion dollars ($925 million, to be exact) in 2016 if it had substituted brand-name combination drugs with cheaper generic versions.
The study, a retrospective analysis of Medicare drug spending from 2011 through 2016, looked at 29 brand-name combination medications. They were separated into three categories: medications that were available in generic form at identical doses; generic medications available at different doses; and therapeutically equivalent generic substitutes (the Nuedexta example above is from the different dose category).
The authors used the antihypertensive drug Exforge as an example of a drug with a generic equivalent available in an identical dose. If Medicare could have made that substitution for the 5,036 beneficiaries using Exforge, it would have meant a savings of $6.8 million in 2016.
For the 10 most costly brand-name combos, the potential savings between 2011 and 2016 would have been an estimated $2.7 billion.
“Promoting generic substitution and therapeutic interchange through prescriber education and more rational substitution policies may offer important opportunities to achieve substantial savings in the Medicare drug benefit program,” the study concluded.