BACKGROUND: Statins are one of the most widely prescribed medication classes for coronary heart disease (CHD) prevention and treatment. The burden of brand statin medication use led payers to implement cost containment policies.

OBJECTIVES: (i) To describe the trends of statins utilization, spending, and price-per prescription; (ii) to assess the impact of generic statin entry on statin utilization; (iii) to explore how Medicaid can take advantage of cost-lowering generic competition.

METHODS: A descriptive trend analysis was conducted. The study period was from quarter 1, 1991 to quarter 4, 2017. Study statins included atorvastatin, cerivastatin, fluvastatin, lovastatin, mevastatin , pitavastatin, pravastatin, rosuvastatin, simvastatin, and their combinations. Trends were compared between each pair of generic and brand-name drugs. The data source was the national pharmacy summary claims of the Medicaid State Drug Utilization Data. Annual number of prescriptions and reimbursement amount were calculated for each of the statins reimbursed by Medicaid. Annual per-prescription spending as a proxy of drug prices were calculated by dividing total reimbursement by the number of prescriptions. Currency amounts were standardized using US Producer Price Index based on the strength of the US dollar in 2018.

RESULTS: From 1991 to 2005, statin prescriptions amount increased from 6.7 million to 27.7 million, and the expenditure increased from $80.4 million to $2.43 billion. Then in 2009, statins utilization decreased to 6.2 million, and the spending decreased to $447 million. In 2017, Medicaid spent $241 million (before rebate) on 20.8 million pharmacy prescription claims for statin medication use. From 2001 to 2017, generics utilization increased to 20.8 million, and spending increased to $202 million. In 2017, generics occupied 99.4% prescription claims but only counted for 84% expenditure.

CONCLUSIONS: Increased statin expenditure paralleled with rising utilization. Drug competition includes inter-brand, generic to brand-name drug, and generic competition. Switching to generics offers significant cost-saving potential for Medicaid programs.