Among topical dermatologic drugs, the mean overpayment for brand-name drugs was more than double that of generics, based on an analysis of claims data of privately insured individuals published in JAMA Dermatology.
“In recent months, state and federal policies have been enacted to ban gag clauses on pharmacists and in commercial insurance contracts,” Joslyn Kirby, MD, MS, MEd, of the department of dermatology, Penn State Milton S. Hershey Medical Center, and colleagues wrote. “Gag clauses prevented pharmacists from proactively informing patients if it is more cost-effective to purchase their prescription out of pocket.”
Researchers defined a “clawback” as an insured patient’s copayment exceeding the insurer’s cost for the drug. In this analysis, a clawback occurrence was defined as a copayment cost exceeding the insurer cost by $2 or more. Sixty-one common dermatologic medications were included in the 5-year analysis.
The overall estimated cost for topical prescription drug overpayments during the study period was $2,633,701.36. For branded topicals, the overpayment per drug claim was $21.02 compared with generic topicals at $9.11.
Triamcinolone, the most frequently prescribed topical agent, had a low rate of overpayment of 0.08%. Three topical corticosteroids, two acne treatment medications and two topical antifungals had the highest overpayments.
Based on medication type, topical retinoids had the highest mean overpayment per individual claim. Moreover, the overpayment was higher for branded retinoids at $63.79 vs. generic retinoids at $23.22.
The analysis was limited to privately insured individuals, and differences by insurance or plan type were not available in the data set, according to researchers. – by Abigail Sutton
Disclosures: The authors report no relevant financial disclosures.