Generic drug prices increase when market competition decreases

1. Generic drug prices increase when market competition decreases

Abstract: http://annals.org/aim/article/doi/10.7326/M16-1432

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Decreased market competition causes generic drug prices to rise significantly, according to an article published in Annals of Internal Medicine. This trend appears likely to continue unless policies are enacted to stabilize generic drug markets in response to a decrease in competition.

Prices for some generic drugs have increased in recent years, adversely affecting patients who rely on them. One review found that the price of digoxin (a commonly prescribed heart medication) increased by 2,800 percent in a single year. Many factors have been linked to these price increases, including shortages in the manufacturing supply chain (leading to reduced production) and a reduction in the number of manufacturers of a drug (resulting in insufficient competition). Although increases in generic drug prices are thought to be the result of insufficient competition, no study has examined this relationship.

Investigators studied prescription drug claims from commercial health plans between 2008 and 2013 to determine the association between market competition levels and changes in generic drug prices. Based on 1.08 billion prescription claims, a cohort of 1,120 generic drugs was identified. The drugs were categorized as having high, medium, or low competition levels. After controlling for other factors, a generic drug in the highest marketing competition group was expected to see a decrease of 32 percent in price over the study period, while a generic drug in the lowest market competition was expected to see a price increase of 47 percent over the same period. In addition, researchers found low market competition levels had a more pronounced correlation with drug prices in lower-priced generic drugs compared with their higher-priced counterparts.

The authors suggest that understanding the connection between competition and price may be helpful in identifying older prescription drugs at higher risk for price change in the future.

Media contact: For an embargoed PDF, please contact Cara Graeff at cgraeff@acponline.org. For an interview with the lead author, Chintan V. Dave, PharmD, please contact him directly at chintandave19@gmail.com.

2. Broader firearm restrictions needed to prevent suicide deaths

Abstract: http://annals.org/aim/article/doi/10.7326/L17-0111

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Limiting firearm access only for persons with a mental health condition or those who previously attempted suicide likely is not enough to reduce suicide deaths. The brief research report is published in Annals of Internal Medicine.

Firearms account for one half of all suicide deaths in the United States. Attempts to reduce access to firearms have focused on persons with a mental health condition or a history of suicidal behavior. Researchers from Kaiser Permanente Colorado-Institute for Health Research, sought to identify the proportion of suicide deaths that could be prevented by limiting firearm access for only persons who fall into one of those two categories.

The researchers reviewed medical records and claims information for 2,674 adults and adolescents who had been enrolled in the Treatment Utilization Before Suicide (TUBS) study in the months prior to their suicide deaths. They found that 54.7 percent of those enrolled had a mental health or substance use condition. Of those, 42.8 percent committed suicide using a firearm. Among those persons who died by suicide with a firearm, only 4.1 percent had previously attempted suicide and just 23.5 percent had a mental health or substance use condition.

Based on these findings, the researchers suggest that firearm restrictions be expanded beyond the current focus on these patients to include other persons at risk for suicide.

Media contact: For an embargoed PDF, please contact Cara Graeff at cgraeff@acponline.org. For an interview with the lead author, Jennifer M. Boggs, MSW, please contact Nick Roper at Nicholas.Mark.Roper@kp.org or 303-905-7451.

3. Demand for FMT likely to increase due to excessive rise in multiply recurrent C diff cases

Abstract: http://annals.org/aim/article/doi/10.7326/M16-2733

Editorial: http://annals.org/aim/article/doi/10.7326/M17-1565

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From 2001 to 2012, the incidence of multiply recurrent C difficile Infection (mrCDI) increased by 188 percent, far exceeding the increase in incidence of CDI (42.7 percent). These data project an increasing demand for therapies to treat mrCDI, which will likely translate into greater use of fecal microbiota transplantation (FMT) in the coming years. The findings of a retrospective cohort study are published in Annals of Internal Medicine.

CDI is the most common health care-associated infection and often recurs after treatment. Up to 50 percent of patients have been shown to have at least one recurrence after an initial episode. Patients with mrCDI are increasingly treated with FMT. An improved understanding of the evolving epidemiology of CDI and its recurrence may allow for earlier identification of patients at high risk for recurrence and also changes in treatment practices, including earlier use of newer therapies, such antimicrobials or FMT.

Researchers at the University of Pennsylvania Perelman School of Medicine studied health records for 38,911,718 commercially insured patients in the OptumInsight Clinformatics Database to evaluate whether incidence of mrCDI is increasing, to determine whether any such increase is proportional to the increase in CDI, and to identify risk factors for mrCDI among patients with an episode of CDI. They found that between 2001 and 2012, incidence of both CDI and mrCDI increased steadily. However, the increased incidence of mrCDI dramatically exceeded the increased incidence of CDI. The excessive increase was apparent thoughout the United States and was independent of other risk factors for CDI.

The authors of an accompanying editorial from VA Ann Arbor Center for Clinical Management Research and University of Michigan discuss the historical challenges in understanding CDI and recurrent infections. They acknowledge that these findings are an important first step in developing a sound strategy to address the growing public health challenge of mrCDI.

Media contact: For an embargoed PDF, please contact Cara Graeff at cgraeff@acponline.org. To speak with the lead author, Gene K. Ma, MD, please contact Queen Muse at Queen.Muse@uphs.upenn.edu.

4. Annals of Internal Medicine Turns 90!

Abstract: http://annals.org/aim/article/doi/10.7326/M17-1482

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July 2017 marks the 90th anniversary of Annals of Internal Medicine. Established in 1927 by the American College of Physicians, Annals has continued without pause to publish new articles first as a monthly journal, then as a twice-monthly journal, and now weekly. George Lundberg, MD, Editor at Large of Medscape and former Editor-in-Chief of the Journal of the American Medical Association recognizes Annals' major milestones in an editorial published in Annals of Internal Medicine.

Media contact: For an embargoed PDF or to speak to Christine Laine, MD, MPH, editor-in-chief of Annals of Internal Medicine, please contact Cara Graeff at cgraeff@acponline.org.

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