OBJECTIVES: Analyze the trend in price, spending, and utilization of orally administered SGAPs over the past 30 years utilizing Medicaid claims database and compares the market share of brands versus generics.

METHODS: Descriptive analysis utilizing the Medicaid claims database of all oral SGAPs approved since 1991 as well as injectable Aristada. NDC codes were used to identify and extract SGAPs. Brand and generic were defined using NDC1 code. Price per prescription was calculated as the total reimbursement divided by the number of prescriptions. Price was defined as the average prescription reimbursement. Spending was defined as total reimbursement for all SGAPs and for each brand and generic. The number of prescriptions were measured to assess the utilization rate. Values were adjusted for inflation using CPI medical.

RESULTS: Total of 22 SGAPs were included of which 8 were generic. Estimated total reimbursement for all SGAPs was $ 223 billion of which market share of brand versus generic was 94% to %7. Brand Risperdal had the highest reimbursement amount which was 29% of the total expenditure while generic Asenapine had the lowest, the trend showed gradual increase in reimbursement until 2005 following fluctuations which was projected to be continued until 2025.The average price per prescription was $298. Brand Invega had the highest average price per prescription of $2940 while generic quetiapine had the lowest with $42.the price rate continued to increase over the year for brands unlike generics. Over 661 million prescriptions and 19.5 million units. Generic prescriptions market share increased to 84% by 2022 while brands decreased to %16.

CONCLUSIONS: The spending on SGAPs increased tremendously over the past 30 years as more brands and generics were introduced to the market. Generic SGAPs had an impact on controlling the cost burden and there was a shift toward prescribing more generic than brand.