Therefore, sitagliptin represents the introduction of an expensive brand name drug, considered a moderately novel diabetes treatment, into a market that contained a large number of both generic and brand name treatment options, plus multiple, highly expensive, insulin alternatives. Sitagliptin was the first dipeptidyl peptidase-4 (DPP-4) inhibitor introduced to the market, but was not considered as a first-line treatment option. Our study aimed to examine local variation in physician adoption of sitagliptin, a first-in-class oral glycemic lowering agent introduced in October 2006, and to investigate the association between physician adoption of sitagliptin and overall anti-diabetic drug spending in two large, and distinct, payer settings (Medicare and Medicaid). Third, the continual introduction of new brand name anti-diabetic drugs complicates physician decision-making and increases the potential for variation in new drug adoption. However, there is little evidence-based guidance for physicians on which medications to prescribe when augmenting therapy. Second, there are multiple FDA approved anti-diabetic drugs available, with varying mechanisms of action, effectiveness, and prices. First, diabetes is a progressive chronic disease that is increasing in prevalence and accounts for a large share of prescription drug and medical spending.
We examine the association between physician adoption and drug spending for diabetes for three reasons. policy makers in the face of ever rising health care expenditures and an aging population that will likely increase demand for chronic disease medications. Improving our understanding of how new drug adoption drives prescription drug spending is paramount for U.S. Studies have evidenced tremendous physician-level variation in adoption speed in several drug categories however, the association between region-level differences of physician adoption of newly introduced brand name drugs and prescription drug spending is still poorly understood. Regional differences in brand name drug prescribing are likely tied to regional differences in the speed with which physicians adopt new drugs.
Much of this variation is attributed to differences in the extent to which physicians prescribe brand name medications as opposed to generic medications, and not to differences in the volume of prescriptions filled, or to patient characteristics. There is substantial regional variation in prescription drug spending in the United States, a finding that is consistent across different classes of drugs, patient populations, and health care payers (e.g.
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