2. Agenda
• What is pulmonary hypertension?
• Pulmonary hypertension groups
• Epidemiology
• Medicare
• PAH drugs
• Research application
• Acknowledgement
• Q&A
3. 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
4.
5. 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
6. 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
7. 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
9. • 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
10. 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% Generics
6.60% Brand Name
Hold Ends
$4,700 Annual OOP threshold
Medicare Part D
11. • 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
12. Brand name Generic name Manufacturer Routes
Medicare
coverage
FDA approval
date for PAH
1 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 inhaled
United
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 treprostinil
United
Therapeutics
Corporation
Oral Part D 2013 Dec
13. Part D
sildenafil
2012
overall 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
14. Part D
ambrisentan
2012
overall 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
15. Part D
bosentan
2012
overall 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
16. Part D
tadalafil
2012
overall 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
17. Part B
epoprostenol
2012
overall 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
18. Part B
iloprost
2012
overall 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
19. Part B
treprostinil
2012
overall 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
20. 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
21. 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
22. Acknowledgements
• Thank you, team
• Dr. Doshi
• Dr. Tianyan Hu
• Dr. Pengxiang Li
• Vrushabh Ladage
• Rish Kumar
• Kevin Huang
