Empirical Time-Series Analysis (1991–2023) of Immune Thrombocytopenia Medications in U.S. Medicaid Programs
Author(s)
shireen Halloush, MS , PhD student1, Jianfei (Jeff) Guo, BSc, MSc, PhD2;
1university of Cincinnati, PhD student, Cincinnati, OH, USA, 2university of Cincinnati, Cincinnati, OH, USA
1university of Cincinnati, PhD student, Cincinnati, OH, USA, 2university of Cincinnati, Cincinnati, OH, USA
OBJECTIVES: Comprehensively examine trends in the utilization, reimbursement, and pricing of ITP medications under US Medicaid programs (1991-2023), identifying patterns and shifts associated with drug approvals, biosimilar entry, and evolving clinical guidelines.
METHODS: National Medicaid pharmacy claims summary data files from Center for Medicare and Medicaid Service were extracted and analyzed annually from 1991 to 2023. Treatment approaches target platelet count restoration and immune system modulation are study medications, including thrombopoietin receptor agonists (TPO-RA), IV immunoglobulin or anti-D immunoglobulin, anti-CD20 monoclonal antibody, and newer Tyrosine kinase inhibitor. These medications were categorized into therapeutic classes and analyzed as trends in utilization , reimbursement , and drug price over time. Comparative market-share analyses were conducted across therapeutic classes to identify key drivers of market changes, including policy shifts, competition, and new drug entries
RESULTS: The utilization trends revealed Rituxan dominated until 2020, after biosimilars (Ruxience, Truxima) gained traction, with Ruxience leading. In the IVIG category, Gammagard consistently held the highest utilization, peaking in 2022, followed by Rhophylac and Privigen. Among TPO-RAs, Promacta surpassed Nplate in 2018, reflecting a shift in prescribing patterns. Pricing data highlighted Promacta as the most expensive TPO-RA, Panzyga led IVIG pricing by 2019. Despite a price decline after biosimilar approvals, Rituxan remained the costliest in its class. Reimbursement trends mirrored utilization, with Rituxan historically leading, followed by biosimilars. Gammagard achieved the highest IVIG reimbursement, while Promacta overtook Nplate post-2018. IVIG had the highest utilization, but Rituxan maintained the largest reimbursement share due to its historical dominance.
CONCLUSIONS: This analysis highlights evolving patterns in the utilization, reimbursement, and pricing of ITP therapies within Medicaid programs, shaped by factors like the introduction of biosimilars, competitive market dynamics, and clinical advancements. These findings provide valuable insights for healthcare policymakers, payers, and clinicians to optimize treatment access, manage costs, and enhance outcomes for patients with ITP.
METHODS: National Medicaid pharmacy claims summary data files from Center for Medicare and Medicaid Service were extracted and analyzed annually from 1991 to 2023. Treatment approaches target platelet count restoration and immune system modulation are study medications, including thrombopoietin receptor agonists (TPO-RA), IV immunoglobulin or anti-D immunoglobulin, anti-CD20 monoclonal antibody, and newer Tyrosine kinase inhibitor. These medications were categorized into therapeutic classes and analyzed as trends in utilization , reimbursement , and drug price over time. Comparative market-share analyses were conducted across therapeutic classes to identify key drivers of market changes, including policy shifts, competition, and new drug entries
RESULTS: The utilization trends revealed Rituxan dominated until 2020, after biosimilars (Ruxience, Truxima) gained traction, with Ruxience leading. In the IVIG category, Gammagard consistently held the highest utilization, peaking in 2022, followed by Rhophylac and Privigen. Among TPO-RAs, Promacta surpassed Nplate in 2018, reflecting a shift in prescribing patterns. Pricing data highlighted Promacta as the most expensive TPO-RA, Panzyga led IVIG pricing by 2019. Despite a price decline after biosimilar approvals, Rituxan remained the costliest in its class. Reimbursement trends mirrored utilization, with Rituxan historically leading, followed by biosimilars. Gammagard achieved the highest IVIG reimbursement, while Promacta overtook Nplate post-2018. IVIG had the highest utilization, but Rituxan maintained the largest reimbursement share due to its historical dominance.
CONCLUSIONS: This analysis highlights evolving patterns in the utilization, reimbursement, and pricing of ITP therapies within Medicaid programs, shaped by factors like the introduction of biosimilars, competitive market dynamics, and clinical advancements. These findings provide valuable insights for healthcare policymakers, payers, and clinicians to optimize treatment access, manage costs, and enhance outcomes for patients with ITP.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR62
Topic
Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)