Abstract
BACKGROUND: Approximately 14 million U.S. adults may benefit from treatment of hypertriglyceridemia to reduce risk of atherosclerotic cardiovascular disease (ASCVD). While the evidence base for treatment of hypertriglyceridemia has significantly changed over time, patterns of utilization and spending on triglyceride-lowering therapies in the U.S. are not well-understood. METHODS: We used the Medicare Part D Prescriber dataset from 2013 to 2021 to identify all generic and brand name formulations of triglyceride-lowering therapies (fibrates, omega-3 acid ethyl esters, and niacin). We assessed annual expenditures and number of beneficiaries, evaluated trends and assessed potential savings to Medicare if generic medications were used in place of brand names. RESULTS: We identified seventeen oral triglyceride-lowering medications used from 2013-2021. There was a 22 % decline in beneficiaries receiving any triglyceride-lowering therapy and a 32 % reduction in Medicare spending over the study period. For fibrates, overall use declined by 21 % (from 1.6 million to 1.3 million beneficiaries) and spending declined by 67 % (from $735 million to $243 million). For omega-3 acid ethyl esters, overall use increased by 47 % (from 389k to 571k beneficiaries) and spending increased by 101 % (from $461 million to $925 million). For niacin, overall use declined by 87.3 % (from 445k to 56k beneficiaries) and spending declined by 92.9 % (from $431 million to $31 million). When generics became available, expenditure on and number of beneficiaries receiving brand name medications decreased. During the study period, $5.0 billion (41 %) was spent on brand name triglyceride-lowering therapies, and $1.5 billion could have been saved by switching to their respective generic versions when available. CONCLUSIONS: Among Medicare Part D beneficiaries, use and spending on fibrates and niacin declined, while use and spending on omega-3 acid ethyl esters increased. These trends likely reflect changes in the evidence base and guideline recommendations for hypertriglyceridemia treatment. While most beneficiaries received generic medications when available, substantial spending on brand name medications persists, indicating potential missed opportunities for cost savings.