MARKET SHARE AND ECONOMIC TRENDS OF JANUS KINASE INHIBITORS IN U.S. MEDICAID, 2011- 2023
Author(s)
Bahar Mikaeili, BSc1, Zuhair A. Alqahtani, MSc, PharmD1, Ana L. Hincapie, PhD1, Xiaomo (Shawn) Xiong, MS, PhD1, Nihal El Rouby, PharmD, PhD1, Caitrin W. McDonough Rowe, PhD2, Jeff Jianfei Guo, BPharm, PhD1;
1James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA, 2The University of Florida College of Pharmacy, Gainesville, FL, USA
1James L Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA, 2The University of Florida College of Pharmacy, Gainesville, FL, USA
OBJECTIVES: Janus kinase (JAK) inhibitors offer important therapeutic benefits for autoimmune and inflammatory diseases but have high costs that may strain Medicaid budgets. Evaluating market share alongside utilization, spending, and pricing can clarify how prescribing shifts across agents. This study describes utilization, spending, pricing, and market share of Medicaid-reimbursed JAK inhibitors (tofacitinib, upadacitinib, baricitinib, ruxolitinib, fedratinib, abrocitinib, ritlecitinib, momelotinib, and deucravacitinib) in the U.S. from 2011-2023.
METHODS: A retrospective descriptive analysis was conducted using the CMS Medicaid outpatient State Drug Utilization Data (2011-2023) for all FDA-approved JAK inhibitors reimbursed by Medicaid. Main measurements are annual prescription utilization trends, total Medicaid reimbursement, and pricing proxy of reimbursement per prescription and per unit. Annual market share was calculated as each JAK inhibitor’s prescriptions divided by total JAK prescriptions in that year, with less frequently used agents grouped as 'Other'.
RESULTS: Total JAKi utilization increased, peaking at 173,038 prescriptions in 2022, then declined to 151,210 in 2023. Total reimbursement peaked in 2022 ($420 million) and decreased to $341 million in 2023. Cumulative prescriptions were highest for Tofacitinib (617,743) and Upadacitinib (120,820). Price per prescription as well as price per unit increased across most agents, with Upadacitinib reaching the highest average price per prescription ($6,637) and per unit ($255). Market share shifted substantially over time. Tofacitinib dominated 2013-2019 (80-83%) but declined to 73.00% (2020), 65.28% (2021), 51.12% (2022), and 29.27% (2023). Upadacitinib increased from 0.62% (2019) to 11.63% (2020), 20.66% (2021), 26.31% (2022), and 32.16% (2023). Ruxolitinib declined to 5.94% in 2023. Topical Ruxolitinib reached 25.57% in 2023, while Baricitinib rose to 4.18% and 'Other' agents remained approximately 2.88% in 2023.
CONCLUSIONS: Medicaid JAK utilization and spending increased over time, while market share shifted from Tofacitinib toward newer agents. Price growth among several high-cost agents, alongside market diversification, highlights continuing affordability concerns.
METHODS: A retrospective descriptive analysis was conducted using the CMS Medicaid outpatient State Drug Utilization Data (2011-2023) for all FDA-approved JAK inhibitors reimbursed by Medicaid. Main measurements are annual prescription utilization trends, total Medicaid reimbursement, and pricing proxy of reimbursement per prescription and per unit. Annual market share was calculated as each JAK inhibitor’s prescriptions divided by total JAK prescriptions in that year, with less frequently used agents grouped as 'Other'.
RESULTS: Total JAKi utilization increased, peaking at 173,038 prescriptions in 2022, then declined to 151,210 in 2023. Total reimbursement peaked in 2022 ($420 million) and decreased to $341 million in 2023. Cumulative prescriptions were highest for Tofacitinib (617,743) and Upadacitinib (120,820). Price per prescription as well as price per unit increased across most agents, with Upadacitinib reaching the highest average price per prescription ($6,637) and per unit ($255). Market share shifted substantially over time. Tofacitinib dominated 2013-2019 (80-83%) but declined to 73.00% (2020), 65.28% (2021), 51.12% (2022), and 29.27% (2023). Upadacitinib increased from 0.62% (2019) to 11.63% (2020), 20.66% (2021), 26.31% (2022), and 32.16% (2023). Ruxolitinib declined to 5.94% in 2023. Topical Ruxolitinib reached 25.57% in 2023, while Baricitinib rose to 4.18% and 'Other' agents remained approximately 2.88% in 2023.
CONCLUSIONS: Medicaid JAK utilization and spending increased over time, while market share shifted from Tofacitinib toward newer agents. Price growth among several high-cost agents, alongside market diversification, highlights continuing affordability concerns.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE516
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Thresholds & Opportunity Cost
Disease
No Additional Disease & Conditions/Specialized Treatment Areas