Thread by @DusetzinaS

We have a new study out today in @Health_Affairs on #PartD. Bear with me because the findings are a little crazy. You can find the paper here:
healthaffairs.org/doi/full/10.13… 1/10

Our big finding: If you need a lot of drugs or some very expensive drugs you would save more money out-of-pocket by using brands instead of generics. 2/10

Yeah, that's right. That doesn't make sense.
This happens because branded drug companies pay discounts in the doughnut hole that count as out-of-pocket spending. Generic drug makers don’t. 3/10

FOCUS!! Stop thinking about doughnuts. This is important. 4/10

What this means is Medicare beneficiaries who use brand-name drugs spend $982 out-of-pocket to get out of the doughnut hole; generic users spend $3,730. 5/10

We show that beneficiaries OVERPAY for generics if they have drug spending between $22,000 and $80,000, even if generics have a discount of 61% (@akesselheim and @US_FDA found this level of discounting with > 4 generic manufacturers). 6/10

This is the WRONG message to send #PartD beneficiaries! Generics should not cost more than brands. 7/10

We need to redesign #PartD to work for people needing high-priced drugs. All of them. And we need to make generics CONSISTENTLY less expensive for patients than brands. @SenFinance @WaysMeansCmte @SenateAging are all considering options for redesigning Part D. 8/10

We could fix this under the current design by removing discounts for brands. OR, better, we could look to options like those proposed by @medicarepayment and @TKO_Hayes from American Action Forum to change the benefit, add an out-of-pocket cap while we are at it. 9/10

Take a read if you have a chance!
healthaffairs.org/doi/full/10.13… 10/10

Shout out to my awesome PhD student collaborators @unchpm and @UNCPharmacy: Shelley Jazowski, @ashleycolemckee, and Joehl Nguyen (who I still can't convince to be on Twitter!).