Direct-to-consumer ads associated with higher Medicaid costs

November 23, 2009

Direct-to-consumer advertising (DTCA) for a commonly prescribed antiplatelet drug does not appear associated with increased use, but may be associated with increased drug costs and Medicaid pharmacy expenditures, according to a report in the November 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"The cost of drugs to public and private health insurance programs has been a long-standing source of concern among policy markers," the authors write as background information in the article. Millions of Americans are enrolled in publicly funded Medicare Part D programs. In addition, prescription drugs are cited as one of the three top reasons for Medicaid expenditure growth, and prescription drug costs have increased by an average of 15.4 percent per year between 1994 and 2004. Meanwhile, spending for DTCA has increased more than 330 percent in the last 10 years.

Michael R. Law, Ph.D., of Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada, and colleagues studied the association between DTCA and the use and cost of clopidogrel, a commonly used and heavily marketed (as Plavix) antiplatelet agent. Researchers examined pharmacy data from 27 state Medicaid programs from 1999 to 2005. Changes in the amount of units sold, costs per unit and total pharmacy expenditures after DTCA initiation were noted.

There was no DTCA for clopidogrel from 1999 to 2000. From 2001 to 2005, U.S. spending on DTCA for clopidogrel exceeded $350 million, an average of $70 million per year.

Clopidogrel use in the 27 Medicaid programs did not change after DTCA. However, cost per unit per quarter increased by $0.40 (12 percent) after DTCA for the drug began, leading to an added $40.58 in pharmacy costs per 1,000 Medicaid enrollees per quarter. "Overall, this change resulted in an additional $207 million in total pharmacy expenditures," the authors write.

"Consequently, payers and policy makers should appropriately still be concerned about DTCA increasing total drug costs for publicly funded reimbursement programs such as Medicaid and Medicare. Future longitudinal studies should examine other drugs and settings because many other countries are currently considering whether to permit DTCA," the authors conclude.
(Arch Intern Med. 2009;169[21]:1969-1974. Available pre-embargo to the media at

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

The JAMA Network Journals

Related Clopidogrel Articles from Brightsurf:

Study reveals best anti-clotting strategy after heart valve intervention
The POPular TAVI trial has challenged current guideline recommendations on antiplatelet treatment after transcatheter aortic valve implantation (TAVI) in patients not taking oral anticoagulation.

Clopidogrel atop rivaroxaban and aspirin shows no added benefit for PAD
The results of VOYAGER PAD found that people with peripheral artery disease (PAD) who took the blood thinner rivaroxaban with aspirin after undergoing lower extremity revascularization -- a procedure to treat blocked arteries in the leg -- had a significant reduction in the risk of major adverse limb and cardiovascular events when compared with those receiving aspirin alone, according to a subgroup analysis from VOYAGER PAD presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

Improving cardiovascular health of the most vulnerable
A two-year pilot project led by Rick Stouffer, MD, shows how the cardiovascular health of the most vulnerable patients can be improved with free medications.

Ticagrelor is as safe and effective as clopidogrel after heart attack
Patients given clot busters to treat a heart attack fared equally well if they were given the standard blood thinning medication clopidogrel versus the newer, more potent drug ticagrelor, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Stopping DAPT after one-month improved outcomes in stent patients
Patients who stopped taking aspirin one month after receiving a stent in the heart's arteries but continued taking the P2Y12 inhibitor clopidogrel fared significantly better after one year compared with those who followed the standard practice of continuing both medications, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Cilostazol-combo antiplatelet therapy reduced risk for recurrent stroke
The long-term combination of cilostazol with aspirin or clopidogrel resulted in fewer recurrent strokes than with aspirin or clopidogrel alone in high-risk patients.

Modern antiplatelet therapy: When is clopidogrel the right choice?
In the current issue of Cardiovascular Innovations and Applications (Volume3, Number 2, 2018, pp.

International study suggests combination therapy may prevent stroke in certain people
Results from an international clinical trial of more than 4880 participants, published in the New England Journal of Medicine, show that combining clopidogrel and aspirin following a small stroke or experiencing minor stroke symptoms decreases risk of a new stroke, heart attack or other ischemic event within 90 days.

Stroke prevention drug combo shows promise, study says
If you've had a minor stroke or a transient ischemic stroke (TIA), taking the clot-preventing drug clopidogrel along with aspirin may lower your risk of having a major stroke within the next 90 days, according to new research published in The New England Journal of Medicine.

Ticagrelor has comparable safety to clopidogrel after heart attack
Among people younger than 75 years who were given clot busters to treat a heart attack, taking the more potent blood thinner ticagrelor did not increase the risk of major bleeding (the primary endpoint) compared with the standard blood thinner clopidogrel, in a trial being presented at the American College of Cardiology's 67th Annual Scientific Session.

Read More: Clopidogrel News and Clopidogrel Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to