jalpa presentation

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




mean cost per 30-day claim $6243 (385) $6239 (377) $6251 (396)



$53031 (26559) $54664 (26399)


ambrisentan

Part D bosentan







$60207 (23123) $62875 (22195)


bosentan

Part D tadalafil






mean cost per user $10461 (6194) $10446 (6116) $10576 (6274)


tadalafil

Part B epoprostenol



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)


$41622 (29764) $38722 (24189)


epoprostenol

Part B iloprost







$87093 (52051) $93686 (54944)

mean OOP cost per user $18003 (10656)

$17440 (10417) $18749 (10996)

iloprost

Part Btreprostinil







$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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