Otsuka's Abilify leads Medicaid spending, report finds, with Gilead's hep C meds close behind

Amid a period of intense drug pricing scrutiny, data are out on the costliest drugs to Medicaid, with some of pharma's biggest names among the highest-ranking brands. It's a tale of the Medicaid population--more likely to be treated for hep C and HIV, plus mental health disorders--and the sometimes pricey drugs they're prescribed.

A new report by the Kaiser Commission on Medicaid and the Uninsured shows that, of the top 19 costliest medicines to Medicaid, all cost more per prescription than at least three-fourths of other meds. The program put up $27.4 billion in outpatient drug spending in 2014.

Sitting at the top was Otsuka's antipsychotic drug Abilify, priced higher per prescription than 90% of all drugs used by Medicaid patients, and among the most-prescribed meds in the program. The report covers January 2014 to June 2016, so timing may have played a factor in the results; Abilify lost patent protection in mid-2015 and Otsuka raised the prices as the med neared the patent cliff, "a strategy often seen before a brand drug’s patent expires," Kaiser Commission points out.

Behind Abilify in total Medicaid spending were Gilead Sciences’ ($GILD) hepatitis C treatment Sovaldi--costing more than 99% of other meds while prescribed more frequently than 90%. Rounding out the top were Shire’s ($SHPG) ADHD med Vyvanse, Gilead’s hep C combo Harvoni and HIV fighter Truvada, and Sanofi’s ($SNY) basal insulin for diabetics, Lantus.

Many of the drugs on the most-costly list treat behavioral health conditions for which Medicaid is a major provider, Kaiser Commission pointed out. Medicaid provides access to more than 70 million people.

On a per-prescription basis, Novo Nordisk’s ($NVO) rare disease drug for hemophilia, NovoSeven RT, topped the list at a price of $58,843 before rebates; fellow hemophilia treatment Koate-DVI followed closely behind at $57,162. Many of the drugs at the top of the per-prescription cost list are those for serious health conditions such as hemophilia, multiple sclerosis or rare infant diseases. Baxalta ($BXLT) hemophilia med Feiba landed at third at a per-prescription cost of $48,366 before rebates and Sigma-Tau's rare disease med Adagen, costing $44,551, was fourth.

Mallinckrodt's ($MNK) H.P Acthar Gel--which has had a history of pricing controversy dating back to previous owner Questcor--ended up near the top of the list at No. 5, costing Medicaid $43,877 before rebates.

Sovaldi and Harvoni, with their infamous list prices of $84,000 and $94,500 respectively, ranked outside of the top 15 in per-prescription costs to Medicaid. Harvoni ended up at No. 16 and Sovaldi at No. 24, with their per-prescription costs to the program at $28,977 and $26,612 before rebates, according to the report.

The most frequently prescribed drug over the period was hydrocodone-acetaminophen, information that could play a role in an effort by federal authorities to rein in opioid prescriptions and tackle an epidemic of addiction.

Only a handful of generics made the top 50 costliest meds list. Ninety-four percent of the top 50 were brands, while brands accounted for just 45% of all Medicaid drugs.