OBJECTIVES : The use of direct oral anticoagulants (DOACs) is widely increasing in the United States (US). Warfarin and Acenocoumarol, a vitamin K antagonist (VKA), were the only oral anticoagulants used in the past few decades and are now been gradually replaced for the DOACs. The objective of the study was to analyze trends in utilization, reimbursement, and price for anticoagulants in the US Medicaid population from 2000 through 2018.

METHODS : Retrospective data analysis was conducted using the National Summary Files for the Medicaid State Drug Utilization Data from the Centers for Medicare & Medicaid Services (CMS). Data were collected in order to assess the utilization and reimbursement from the first (calendar) quarter of 2000 through to the second quarter of 2018 restricted for outpatient prescriptions only. The reimbursement and price were calculated using SAS software Version 9.4 (Cary, NC, USA) and Microsoft Office Excel.

RESULTS : During the 18-year study period, a substantial rise in Medicaid expenditures on DOACs was observed. Moreover, the utilization of DOACs has increased significantly since their approval, especially for Xarelto (rivaroxaban). The spending on DOACs per prescription by Medicaid increased from an average of $200 in 2011 to $350 in 2017 peaking at $450 for Xarelto. Conversely, the total number of Medicaid-reimbursed prescriptions of Warfarin and Coumadin decreased from 7 million to almost 3 million and from 4 million to less than a million respectively.

CONCLUSIONS : Overall, by analysis of the Medicaid database, expenditures and the number of prescriptions for Coumadin and Warfarin decreased while the utilization and, mainly, expenditures for DOACs increased over the study period.