title: Utilization and cost of anti-osteoporosis therapy among US Medicare beneficiaries.
abstract: There is a strong impetus to prevent and treat osteoporosis to prevent fractures. $990 million dollars was spent on anti-osteoporosis drugs in 2013. As we shift our focus on primary prevention of fractures, providers are encouraged to find the most cost-effective anti-osteoporosis therapy for patients.
  
  
  
  Osteoporosis is a major global problem with osteoporotic fractures posing a potentially avoidable burden on healthcare resources. We studied the utilization and cost of anti-osteoporotic therapy using the 2013 Medicare Part D data.
  
  
  
  Descriptive data were produced from Microsoft Excel and SPSS regarding the anti-osteoporotic drugs of interest.
  
  
  
  In total, Medicare and its beneficiaries spent approximately $990 million on anti-osteoporotic therapy in 2013. Despite this cost, only one in two adults with osteoporosis aged 65 and older received a prescription for an anti-osteoporosis drug. $756 million (77 %) was attributable to brand name drugs which accounted for 2,459,931 claims (22 %). Generic dispensing rate varied from 57-86 % (mean 77 ± 6) across the different states in the USA. States that mandate substitution with generic equivalents had a higher generic dispensing rate compared to the states that permit generic substitution (92 vs. 90 %; p < 0.05). After adjusting for claim counts, we found that if the states that permit substitution with generic equivalents showed the same generic dispensing rate of 92 % as the states that mandate such substitution, there is a potential for savings of $7.5 million, approximately 9 % of the total expenditure in these states on oral bisphosphonates alone. Thirty-eight percent of the total prescriptions from orthopedic surgeons were for Forteo® or Prolia® compared to 12.5 % from specialists.
  
  
  
  These findings highlight the need for ongoing training for physicians who engage in the care of patients with osteoporosis to manage the disease in a cost-effective manner.
authors: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, Bldg 10-CRC, Room 4-1341, Bethesda, MD, USA. smita.jha@nih.gov.
authors: Smita
authors: S
authors: Jha
authors: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, Bldg 10-CRC, Room 4-1341, Bethesda, MD, USA.
authors: Timothy
authors: T
authors: Bhattacharyya
mesh_terms: D000328:Adult; D000368:Aged; D050071:Bone Density Conservation Agents / Q000191:economics / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D054524:Medicare Part D / Q000706:statistics & numerical data*; D008875:Middle Aged; D020380:Needs Assessment; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000517:prevention & control; D014481:United States / Q000453:epidemiology
chemical_list: D050071:Bone Density Conservation Agents
keywords: Brand name drugs; Cost; Generic drugs; Osteoporosis; Primary care providers; Utilization