Study evaluates costs of overactive bladder medications


“Our aim overall is to describe Medicare Part D prescription drug coverage and use of prior authorization and step therapy for these medications,” says Katherine Shapiro, MD.

In this video, Katherine Shapiro, MD, discusses the background behind the Urology paper “Analyzing Access and Costs of Oral Medications for Overactive Bladder (OAB): Uncovering Disparities?” Shapiro was a fellow in female pelvic medicine and reconstructive surgery at New York University in New York, New York at the time of the study.


Please describe the background for this study.

First of all, I would like to thank you for the opportunity to discuss this research. It is a topic that does not have a lot of transparency, and I think a lot of providers who care for patients with overactive bladder will relate to this and hopefully, this research can help with some of their frustrations when it comes to medication therapy for overactive bladder. Overactive bladder is defined by urinary urgency, frequency, nocturia, and urinary incontinence. Medication therapy is a mainstay of treatment if the patient has not met his or her treatment goals. Overactive bladder medications fall into 2 categories: anticholinergics and beta 3 agonists. Anticholinergic side effects can include constipation, dry mouth, and dry eyes, but there is emerging research detailing the negative cognitive impact of these medications. A newer drug, mirabegron [Myrbetriq], which is a beta 3 agonist, has minimal side effects relative to the older anticholinergic treatments. The main side effect is new-onset or worsening hypertension in about 2% of patients. But this class has not been associated with any cognitive changes, and so providers often use these side effect profiles to determine which medications should be prescribed. However, the answer is not always that simple. And insurance coverage and ultimately, out-of-pocket costs, often dictate which medication a patient can receive. As a large part of the patient population are Medicare beneficiaries, it is important to understand plans and insurance coverage, which can vary among the different overactive bladder medications. Also, there may be various hurdles that patients and providers have to go through, such as prior authorizations or step therapy requirements. Our aim overall is to describe Medicare Part D prescription drug coverage and use of prior authorization and step therapy for these medications. We also aim to estimate coverage retail prices for each product and out-of-pocket costs for Medicare beneficiaries and for patients also paying without insurance that may use GoodRx coupons or discount pharmacies like the Mark Cuban Cost Plus Drug Company, which is becoming more popular. This is a cross sectional analysis of the Centers for Medicare & Medicaid Services Prescription Drug Plan formulary data from quarter 1 in 2022. The data included drug-level information on plan coverage, pre-rebate unit prices, and use of prior authorization and step therapy for all of the 5721 Part D plans.

This transcript was edited for clarity.

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