title: Impact of the Medicare Modernization Act of 2003 on utilization and spending for medicare part B-covered biologics in rheumatoid arthritis.
abstract: OBJECTIVE
  To examine changes in utilization and expenditures for infliximab in rheumatoid arthritis (RA) patients associated with the 2 changes implemented by the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003, specifically 1) reductions in physician reimbursement for Part B drugs between 2003 and 2005 and 2) availability of alternative RA biologics in 2006.
  
  
  METHODS
  Using 2002-2006 5% Medicare files, nationally representative estimates of infliximab use and expenditures were estimated in annual cross-sectional samples of RA beneficiaries. Infliximab initiation and continuation rates were estimated in 2-year longitudinal cohorts (2005-2006 versus 2002-2003, 2003-2004, and 2004-2005).
  
  
  RESULTS
  Total payments (in 2006 dollars) for infliximab increased from $357 million in 2002 to $492 million in 2006. The largest annual increase in infliximab payments occurred in the pre-MMA period from 2002 to 2003, wherein payments per RA patient increased by 31%. From 2003 to 2004, despite the reduction in payments brought by the MMA, there was a 4% increase in total expenditures for infliximab per RA patient driven by an increase in utilization factors. Total payments for infliximab per RA patient actually decreased from 2004 to 2005, when reimbursement was further reduced. Continuation and initiation rates for infliximab use remained unchanged in 2006, as compared with previous years.
  
  
  CONCLUSIONS
  Infliximab expenditures increased from 2002 to 2006, yet the passage of the MMA was associated with a remarkable slowdown in the rate of increase in expenditures. There was no evidence of significant substitution of infliximab with other biologics made available in 2006.
authors.affiliation: University of Pennsylvania School of Medicine and Leonard Davis Institute of Health Economics, Philadelphia, PA 19104-6021, USA. jdoshi@mail.med.upenn.edu
authors.forename: Jalpa A
authors.initials: JA
authors.lastname: Doshi
authors.forename: Pengxiang
authors.initials: P
authors.lastname: Li
authors.forename: Andrea
authors.initials: A
authors.lastname: Puig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000191:economics*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001685:Biological Factors / Q000191:economics*; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D016345:Medicare Part B / Q000191:economics* / Q000639:trends; D054524:Medicare Part D / Q000191:economics*; D008875:Middle Aged; D012052:Reimbursement, Incentive / Q000191:economics* / Q000639:trends; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D001685:Biological Factors; D000069285:Infliximab
references.citation: J Health Econ. 1991;10(4):385-410
references.pmid: 10117011
references.citation: Adv Health Econ Health Serv Res. 1984;5:129-60
references.pmid: 10300352
references.citation: J Health Polit Policy Law. 1989 Fall;14(3):587-600
references.pmid: 2794423
references.citation: Arthritis Rheum. 2008 Apr;58(4):939-46
references.pmid: 18383356
references.citation: Ann Rheum Dis. 2004 Nov;63(11):1372-8
references.pmid: 15020312
references.citation: J Health Polit Policy Law. 1989 Fall;14(3):601-20; discussion 621-5
references.pmid: 2507625
references.citation: Ann Intern Med. 2008 Jan 15;148(2):124-34
references.pmid: 18025440
references.citation: J Health Polit Policy Law. 1985 Winter;9(4):595-609
references.pmid: 3919082
references.citation: J Health Econ. 1998 Dec;17(6):675-99
references.pmid: 10339248
references.citation: Am J Manag Care. 2005 Mar;11(3):173-80
references.pmid: 15786856
references.citation: Health Serv Res. 1992 Apr;27(1):65-79
references.pmid: 1563954
references.citation: Arch Intern Med. 2006 Jan 9;166(1):57-63
references.pmid: 16401811
references.citation: Med Care. 1983 Aug;21(8):803-15
references.pmid: 6350746
references.citation: Arthritis Rheum. 2004 Dec 15;51(6):952-7
references.pmid: 15593102