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Out‐of‐pocket costs of biologic treatments for chronic rhinosinusitis with nasal polyposis in the Medicare population

Out‐of‐pocket costs of biologic treatments for chronic rhinosinusitis with nasal polyposis in the... In June 2019, dupilumab became the first biologic therapy to receive US Food and Drug Administration (FDA) approval for add‐on maintenance treatment of adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). The FDA subsequently approved omalizumab (nasal polyps with inadequate response to nasal corticosteroids) and mepolizumab (CRSwNP) for similar indications in November 2020 and July 2021, respectively. Recent debate has focused on whether these biologics are cost‐effective from the perspective of insurers and patients.1Although manufacturer net prices may exceed $30,000 per year, little is known about the extent to which patients incur out‐of‐pocket costs for these therapies.2,3 Prior research has demonstrated that patients with asthma commonly discontinue these biologics due to the high cost of therapy.4 We therefore sought to estimate out‐of‐pocket costs for Medicare patients receiving treatment with biologics for CRSwNP.MATERIALS AND METHODSUsing previously described methods,5 we conducted a cross‐sectional analysis of Medicare Part D plans using the publicly available Centers for Medicare & Medicaid Services Prescription Drug Plan Formulary Quarter 2 2021 database file. We first determined whether each plan covered dupilumab, omalizumab, or mepolizumab; Medicare coverage is not indication‐based and plan coverage decisions thus apply to all FDA‐approved indications. For each covered biologic, http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Forum of Allergy & Rhinology Wiley

Out‐of‐pocket costs of biologic treatments for chronic rhinosinusitis with nasal polyposis in the Medicare population

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References (13)

Publisher
Wiley
Copyright
© 2022 ARS‐AAOA, LLC.
ISSN
2042-6976
eISSN
2042-6984
DOI
10.1002/alr.22976
Publisher site
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Abstract

In June 2019, dupilumab became the first biologic therapy to receive US Food and Drug Administration (FDA) approval for add‐on maintenance treatment of adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). The FDA subsequently approved omalizumab (nasal polyps with inadequate response to nasal corticosteroids) and mepolizumab (CRSwNP) for similar indications in November 2020 and July 2021, respectively. Recent debate has focused on whether these biologics are cost‐effective from the perspective of insurers and patients.1Although manufacturer net prices may exceed $30,000 per year, little is known about the extent to which patients incur out‐of‐pocket costs for these therapies.2,3 Prior research has demonstrated that patients with asthma commonly discontinue these biologics due to the high cost of therapy.4 We therefore sought to estimate out‐of‐pocket costs for Medicare patients receiving treatment with biologics for CRSwNP.MATERIALS AND METHODSUsing previously described methods,5 we conducted a cross‐sectional analysis of Medicare Part D plans using the publicly available Centers for Medicare & Medicaid Services Prescription Drug Plan Formulary Quarter 2 2021 database file. We first determined whether each plan covered dupilumab, omalizumab, or mepolizumab; Medicare coverage is not indication‐based and plan coverage decisions thus apply to all FDA‐approved indications. For each covered biologic,

Journal

International Forum of Allergy & Rhinology – Wiley

Published: Oct 1, 2022

Keywords: chronic rhinosinusitis; dupilumab; Medicare Part D; mepolizumab; nasal polyposis; omalizumab; out‐of‐pocket

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