title: Trends in the utilization of, spending on, and prices for outpatient antifungal agents in US Medicaid programs: 1991-2009.
abstract: BACKGROUND
  The incidence of invasive fungal infections (IFIs) has increased substantially in the recent past. Advances in medical technology, including broad-spectrum antibiotics, may increase the risk for fungal infections. Moreover, immunocompromised patients with cancer, HIV/AIDS, and/or transplants are susceptible to IFIs. Meanwhile, superficial fungal infections (SFIs) are common and can be difficult to cure.
  
  
  OBJECTIVE
  To provide a historical perspective on a dynamic market with expensive medications, this study describes trends in the utilization of, spending on, and average per-prescription spending on outpatient antifungal medications individually, in classes (for IFIs or SFIs), and overall, by the US Medicaid programs from 1991 to 2009.
  
  
  METHODS
  The publicly available Medicaid State Drug Utilization Data, maintained by the Centers for Medicare & Medicaid Services, were used. Annual prescription counts and reimbursement amounts were calculated for each of the antifungals reimbursed by Medicaid. Average per-prescription spending as a proxy for drug price was calculated by dividing reimbursement by the number of prescriptions.
  
  
  RESULTS
  Overall utilization for Medicaid beneficiaries remained steady, with 4.56 million prescriptions in 1991 and 4.51 million in 2009. Expenditures rose from $93.87 million to $143.76 million (in current-year US$) over the same time period. The drop in the utilization of first-generation azoles over the last 5 years of the study period can be explained in part by the movement of dual-eligibles from Medicaid to Medicare Part D and in part to a rise in fungal infections better treated with second-generation azoles or echinocandins. Whereas the average per-prescription price for generic (oral) fluconazole was $8 in 2009, the price per prescription of branded (intravenous) voriconazole was $2178.
  
  
  CONCLUSIONS
  Overall spending by Medicaid on outpatient antifungal medications increased more slowly than did the growth of the Medicaid programs from 1991 to 2009. However, the utilization of antifungal agents for IFIs increased almost 10-fold over this period, far outpacing the rise in the number of Medicaid beneficiaries.
authors.affiliation: James L. Winkle College of Pharmacy, Academic Health Center, University of Cincinnati, Ohio, USA.
authors.forename: Vibha C A
authors.initials: VC
authors.lastname: Desai
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Cavanaugh
authors.forename: Christina M L
authors.initials: CM
authors.lastname: Kelton
authors.forename: Jeff J
authors.initials: JJ
authors.lastname: Guo
authors.forename: Pamela C
authors.initials: PC
authors.lastname: Heaton
mesh_terms: D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D016527:Drug Costs / Q000639:trends; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use*; D005102:Health Expenditures / Q000639:trends; D006801:Humans; D008484:Medicaid / Q000191:economics* / Q000639:trends; D009181:Mycoses / Q000188:drug therapy* / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000935:Antifungal Agents; D016568:Drugs, Generic