Access barriers and cost of varenicline for smoking cessation: A national comparative analysis of Medicare standalone part D and Medicare Advantage plan.

person Changchuan Jiang Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern, Dallas, TX info_outline Changchuan Jiang, Qian Wang, Arthur S Hong, Megan A Mullins, Jiazhang Xing, Tianci Wang, Xin Hu, Ryan David Nipp, Robin Yabroff, Joshua Liao, Xuesong Han, Ya-Chen Tina Shih

Authors person Changchuan Jiang Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern, Dallas, TX info_outline Changchuan Jiang, Qian Wang, Arthur S Hong, Megan A Mullins, Jiazhang Xing, Tianci Wang, Xin Hu, Ryan David Nipp, Robin Yabroff, Joshua Liao, Xuesong Han, Ya-Chen Tina Shih Organizations Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, University of Texas Southwestern Medical Center, Dallas, TX, Peking Union Medical College Hospital, Beijing, China, Texas Christian Univerisity, Fort-Worth, TX, University of Virginia School of Medicine, Charlottesville, VA, University of Oklahoma, Oklahoma City, OK, Department of Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, UT Southwestern Medical Center, Dallas, TX, American Cancer Society, Atlanta, GA, School of Medicine, University of California, Los Angeles, Los Angeles, CA Abstract Disclosures Research Funding University of Texas Southwestern Medical Center Background: Smoking cessation is a critical part of cancer prevention and control. Oral varenicline is the most cost-effective medication for smoking cessation, yet seniors enrolled in Medicare Part D Prescription Drug Plans (PDPs) can potentially face costs and access barriers to varenicline in the forms of prior authorization and quantity limits. Although over half of Medicare beneficiaries are now insured and receiving drug benefits through Medicare Advantage, it remains unclear how costs and access barriers compare between PDPs and MA drug plans (MADPs). This study compared plan-level costs and prevalence of prior authorization and quantity limit policies between PDPs and MADPs for oral varenicline. Methods: We used 2023 Q3 MA and PDP data from the Center for Medicare and Medicaid Services, excluding employer-sponsored and Supplemental Need Plans (including dual-eligible plans) and plans with <10 enrollees. We focused on two generic varenicline forms: 0.5mg and 1mg tablets. To compare medication quantities, we calculated the plan-level median (IQR) cost for 30-day supply, based on the average unit cost. Price benchmarks were defined based on average wholesale acquisition cost (WAC) from Micromedex Red Book. T-test and Chi-squared tests were used to compare costs and prevalence of prior authorization and quantity limits. Results: Across 3512 MADPs and 813 PDPs, median costs for a 30-day supply of varenicline were similar (0.5mg tab: $375.32 vs. $376.87, p=0.64; 1mg: $371.88 vs. $376.87, p=0.49, respectively). Median costs for both PDPs and MAPDs were higher than benchmarks; p<0.01 for all). For both varenicline dosages, MAPDs had higher rates of prior authorization (27.1% vs 16.2%, p<0.01) and quantity limits (48.0% vs 30.4%, p<0.01) than PDPs. Conclusions: Varenicline prices in both PDPs and MAPDs were much higher than benchmarks. Compared to PDPs, MAPDs used more prior authorization and quantity limit to control cost. This can create access barriers to this cost-effective medication, burdening patients, physicians, health systems, and pharmacies. Varenicline 2023Q3 PA% QL% Median Cost (IQR) for 30 days supply (USD) Benchmark WAC 0.5mg MAPD 27.1 48.0 375.32 (308.32-379.64) 328.92 PDP 16.2 30.4 376.87 (364.66-386.33) 1mg MAPD 27.1 48.0 371.88 (323.77-405.63) 317.97 PDP 16.2 30.4 376.87 (356.53-379.64) Notes: MADPs=Medicare Advantage Drug Plans. PDPs=Prescription Drug Plans. PA=prior authorization. QL=quantity limit.