{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T17:26:49Z","timestamp":1767374809539,"version":"3.37.3"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T00:00:00Z","timestamp":1666310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Antiretroviral (ARV) medications to treat human immunodeficiency virus (HIV) are a major contributor to Medicaid prescription drug spending. Despite having been used for over 3 decades, the first generic ARVs only recently became available, and many newer versions continue to be sold at high prices despite within-class competition. We estimated Medicaid spending on ARVs from 2007 through 2019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using public Medicaid State Drug Utilization data, we identified trends in ARV spending and use from 2007 through 2019. We estimated net spending and average prices (spending per 30-day supply), accounting for statutory Medicaid rebates, including a 15%\u201323% base rebate plus additional rebates if a drug's price increased faster than inflation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 48 ARVs, estimated net Medicaid spending from 2007 through 2019 was $25 billion for 17 million 30-day supplies. Annual use increased 118%, from 0.7 million 30-day supplies in 2007 to 1.6 million in 2019. During this time, estimated annual net spending increased 178%, from $1.1 billion to $3.0 billion, and average net prices increased 28%, from $1432 to $1830 per 30-day supply.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Annual Medicaid net spending on ARVs nearly tripled from 2007 to 2019, due to a combination of expanded use and rising prices. Medicaid did not extract expected benefits from its mandatory inflationary rebates because they were offset by use of newer, more expensive ARVs. To better control spending related to products with incremental innovation, the US government should be authorized to assure that launch prices for new drugs are aligned with the added benefit they offer over existing therapies.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciac833","type":"journal-article","created":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T07:37:58Z","timestamp":1666337878000},"page":"833-841","source":"Crossref","is-referenced-by-count":1,"title":["Medicaid Spending on Antiretrovirals From 2007 Through 2019"],"prefix":"10.1093","volume":"76","author":[{"given":"Bryan S","family":"Walsh","sequence":"first","affiliation":[{"name":"Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron S","family":"Kesselheim","sequence":"additional","affiliation":[{"name":"Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5776-3293","authenticated-orcid":false,"given":"Benjamin N","family":"Rome","sequence":"additional","affiliation":[{"name":"Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,10,21]]},"reference":[{"author":"KFF","key":"2023030705150251800_"},{"key":"2023030705150251800_","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/bcp.12403","article-title":"The evolution of three decades of antiretroviral therapy: challenges, triumphs and the promise of the future: three decades of antiretroviral therapy","volume":"79","author":"Tseng","year":"2015","journal-title":"Br J Clin Pharmacol"},{"key":"2023030705150251800_","doi-asserted-by":"crossref","first-page":"2286","DOI":"10.1377\/hlthaff.2012.0107","article-title":"Secondary patenting of branded pharmaceuticals: a case study of how patents on two HIV drugs could be extended for decades","volume":"31","author":"Amin","year":"2012","journal-title":"Health Affairs"},{"author":"KFF","key":"2023030705150251800_"},{"author":"Centers for Medicare & Medicaid Services. Unit Rebate Amount Information | Medicaid","key":"2023030705150251800_"},{"key":"2023030705150251800_"},{"key":"2023030705150251800_","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1001\/jama.2020.1012","article-title":"Changes in list prices, net prices, and discounts for branded drugs in the US, 2007\u20132018","volume":"323","author":"Hernandez","year":"2020","journal-title":"JAMA"},{"key":"2023030705150251800_","doi-asserted-by":"crossref","first-page":"3769","DOI":"10.1007\/s11606-022-07435-2","article-title":"Medicaid expenditures and estimated rebates on line extension drugs, 2010\u20132018","volume":"37","author":"Hwang","year":"2022","journal-title":"J Gen Intern Med"},{"author":"US Food and Drug Administration","key":"2023030705150251800_"},{"author":"Centers for Medicare & Medicaid Services","key":"2023030705150251800_"},{"author":"First Data Bank","key":"2023030705150251800_"},{"author":"Centers for Medicare & Medicaid Services","key":"2023030705150251800_"},{"key":"2023030705150251800_","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1377\/hlthaff.2021.00762","article-title":"Raising Medicaid rebates for drugs with accelerated approval: study examines the impact of raising Medicaid rebates for drugs with accelerated approval","volume":"40","author":"Rome","year":"2021","journal-title":"Health Aff"},{"author":"SSR Health","key":"2023030705150251800_"},{"key":"2023030705150251800_","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1377\/hlthaff.2021.00762","article-title":"Raising Medicaid rebates for drugs with accelerated approval","volume":"40","author":"Rome","year":"2021","journal-title":"Health Aff (Millwood)"},{"author":"IBM Corporation. Micromedex Red Book","key":"2023030705150251800_"},{"key":"2023030705150251800_","doi-asserted-by":"crossref","first-page":"492","DOI":"10.18553\/jmcp.2010.16.7.492","article-title":"What is the price benchmark to replace average wholesale price (AWP)?","volume":"16","author":"Curtiss","year":"2010","journal-title":"JMCP"},{"author":"Congressional Budget Office","key":"2023030705150251800_"},{"author":"US Bureau of Labor Statistics. 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