Nationwide Analysis of Anticoagulation Therapy Expenditure and Utilization during COVID-19 Pandemic
Authors: Mehta Mansi , Namjoshi Devang , Mukhtiar Vaibhavi , Bhanushali Charmi , Patel Adit , Seetharaman Kala 
Published: December 2024

Introduction
There has been an increase in the overall healthcare expenditure on anticoagulation therapy in the COVID-19 era given the associated thrombotic complications. Concurrently, there has been a notable increase in the use of Direct Acting Oral Anticoagulants (DOACs), reflecting their superior efficacy and convenience. Given the dynamic trends in anticoagulant prescription and expenditure, estimating spending patterns across various anticoagulant drugs is crucial to help guide healthcare policies and improve their affordability. The aim of this study is to elucidate the trends in Medicare and Medicaid spending and utilization of anticoagulants from 2020 to 2022 during the COVID-19 pandemic.
Methodology:
We obtained data from the publicly available Medicare Part D (prescription drug coverage) and Medicaid database from the Centers for Medicare & Medicaid Services. Data on anticoagulant total spending, total number of claims, number of beneficiaries, average spending/claim, and average spending/beneficiary were extracted. Costs in 2020 were adjusted to 2022 for inflation. Percent change was calculated to compare data from 2020 with 2022.
Results:
Total Medicare Part D spending on apixaban increased sharply in 2022 by 34.4%. The number of beneficiaries for apixaban increased by 33% in 2022, from 2,641,941 to 3,505,142. Importantly, average spending per claim increased by 5.2%, from 763$ to 802$, with an increase in the average spending per beneficiary by 1.3%. Medicaid data showed similarity with an increase in total spending on apixaban by 47% ($986,506,726.45 in 2022), with a 42% increase in total claims. Other DOACs, such as Rivaroxaban, reflected a decrease in average Medicare spending per beneficiary by 3%, with an 11% increase in total beneficiaries. There was an overall decrease in total spending, number of beneficiaries, and average spending/claim with Edoxaban. Average spending per claim with Edoxaban was $617 in 2022, compared to 802$ with apixaban.
In contrast to DOACs, total Medicare spending on warfarin decreased by 39%, and Medicaid spending by 33% with total beneficiaries decreasing by 22%. Average spending per beneficiary was 120$ in 2022 compared to 150$ in 2020. Similar trends were seen with Medicaid spending. For enoxaparin, average spending/claim increased by 200%, however total beneficiaries and total spending decreased by 7% and 36% respectively. Average Medicare and Medicaid spending per claim in 2022 was $1651 ( $1,474.32 for Lovenox and $176.81 for generic enoxaparin) and 497$ respectively. Total Medicare beneficiaries for Dalteparin in 2022 were 111 compared to 298,965 for enoxaparin. Total spending on Dabigatran and Fondaparinux decreased markedly, with a decrease in both the total number of beneficiaries and average spending/claim.
Discussion:
DOACs continue to be a substantial financial burden for both patients and the healthcare system in terms of prescription cost. However, our study did not consider the logistic parameters such as co-pay for patient's PT/INR testing, working hours lost to commute to the coumadin clinic saved by using DOACs. DOACs are more convenient options from a consumer point of view, however, healthcare policy reforms are warranted to ensure appropriate insurance coverage to meet the rising costs of these drugs.