Abstract 13591: Utilization and Spending on Fixed-Dose Combination Treatment for Hypertension in Medicare and Medicaid, 2016-2020

Introduction: ACC/AHA hypertension guidelines recommend fixed-dose combination (FDC) medications for Stage 2 hypertension to improve adherence and blood pressure control. However, utilization, total spending, and generic availability of FDC antihypertensives among U.S. adults are unknown.

Methods: We evaluated total claims in millions (M) and inflation-adjusted spending for all first-line single and FDC antihypertensive medications consisting of ACEi/ARBs, calcium channel blockers, and/or thiazide diuretics in Medicare Part D and Medicaid from 2016 to 2020. We also evaluated use of generic vs. brand-name first-line antihypertensives.

Results: Though total antihypertensive claims increased from 2016 to 2020 in Medicare and Medicaid, use of FDC antihypertensives decreased from 20.6M to 16.9M claims in Medicare (12.6% to 9.4% of all first-line hypertension treatment claims), and from 4.6M to 3.4M claims in Medicaid (12.3% to 8.8%), respectively ( Figure ). Total spending on FDC antihypertensives decreased from $823.3M to $670.9M in Medicare and from $58.9M to $46.9M in Medicaid over this time period. Generically available medications constituted >96% of all Medicare and Medicaid claims in 2016 and >99% of all Medicare and Medicaid claims in 2020 for both single and FDC antihypertensives. Spending on FDC brand-name medications decreased by 87.6% in Medicare ($385.5M to $47.7M) and by 94.1% ($24.9M to $1.5M) in Medicaid.

Conclusions: Though FDC medications are widely recommended for treatment of hypertension and almost exclusively generic, use of these agents in Medicare and Medicaid has decreased from 2016 to 2020. Further efforts are needed to understand the decrease in FDC use and to increase adoption of FDC antihypertensives in clinical practice.