Medications in Single-Dose Vials Implications of Discarded Drugs (2021) / Chapter Skim
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Appendix B: Supplemental Figures and Tables from Commissioned Analyses
Appendix B: Supplemental Figures and Tables from Commissioned Analyses
Pages 127-140
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From page 127... ...
The key findings from those two analyses are described in Chapter 3, but the analyses included a great many results and details that were not included in the chapter. These additional results are provided below in 1 As described in Chapters 2 and 3, the JW modifier is the mechanism through which health care providers can bill and be reimbursed for the discarded portion of a drug from a singledose vial in a way that formally documents the amount of drug that was discarded.
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From page 128... ...
It is important to note that even with the inclusion of the estimated unreported spending, these figures are likely an underestimation of spending on discarded drug because it is not pos sible to calculate potential waste for patient–drug combinations where the JW modifier was never used, which accounts for a sizable percentage of patient–drug combinations. In another analysis to estimate the costs of discarded drugs, the re searchers included only health care providers who used the JW modifier.
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From page 129... ...
(%) Bortezomib 90.5 24.2 27 1.31 25.51 28 Trastuzumab 175 15.9 9 4.20 20.10 11 Romiplostim 48.4 10.6 22 2.01 12.61 26 Paclitaxel Protein-Bound 56 7.6 14 1.05 8.61 15 Carfilzomib 52.1 6.7 13 1.41 8.13 16 NOTES: Top five drugs in terms of spending on claims with the JW modifier, 2018.
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From page 130... ...
130 MEDICATIONS IN SINGLE-DOSE VIALS TABLE B-2 Use of the JW Modifier and Associated Spending Among Medicare Part B Providers Who Sometimes/Always Used Modifier, 2018 Excluding Health Care Including Health Care Providers Who Never Providers Who Never Used JW Modifier Used JW Modifier Percent Percent of Percent Percent of of Claims Spending of Claims Spending with on the JW with on the JW the JW Modifier the JW Modifier Modifier Claims Modifier Claims Belimumab 47.0 3.3 36.3 2.6 OnabotulinumtoxinA 54.9 11.6 36.3 7.9 Daptomycin 42.1 17.5 20.2 9.2 Decitabine 85.4 25.2 74.6 22.6 Golimumab 65.6 9.7 51.2 7.6 Infliximab 22.7 2.2 14.4 1.4 Omalizumab 45.3 10.3 25.2 6.3 Romiplostim 71.1 22.9 67.5 22.0 Tocilizumab 48.8 4.1 34.8 2.9 Azacitidine 84.4 24.6 76.4 22.8 Bortezomib 87.6 29.1 79.7 27.0 Brentuximab Vedotin 67.1 11.3 63.9 10.8 Cabazitaxel 90.1 28.5 85.3 27.2 Carfilzomib 75.4 14.2 68.7 12.9 Cetuximab 46.4 4.0 41.4 3.6 Daratumumab 37.6 1.7 33.0 1.5 Elotuzumab 46.8 5.1 38.8 4.2 Ipilimumab 56.9 8.4 54.0 8.0 Paclitaxel Protein-Bound 73.3 15.3 64.9 13.9 Panitumumab 57.8 6.2 52.7 5.7 Pemetrexed Disodium 51.1 3.3 44.8 2.9 Ramucirumab 59.2 4.5 55.2 4.2 Ado-Trastuzumab Emtansine 63.3 7.1 57.5 6.6 Trastuzumab 65.5 10.5 58.3 9.4 Doxorubicin HCL Peg-Liposomal 22.9 4.4 18.4 3.5 NOTES: Sample of drugs include those with greater than 10 percent claims with the JW modifier in 2018. Excluded health care providers with fewer than 11 claims for a given drug.
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From page 131... ...
Of the 62 drugs with at least one JW modifier claim, the researcher focused specifically on the 25 drugs for which there was at least a 5 percent JW compliance rate at the patient–drug pair level (see Table B-3)
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From page 132... ...
collected the drug claims of these 45 drugs from the Commercial Claims and Encounter databases and the Medicare Supplemental Databases in IBM MarketScan data in 2017. Then, they linked the HRA data with the drug claims to select patients with known weight/height; the final study cohort included 4,688 patients (see Figure B-1)
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From page 133... ...
Indicates multiple brand and/or generic names for a specific Healthcare Common Procedure Coding System code.
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From page 134... ...
Of the 4,688 patients in the study cohort (see Figure B-7) , the researchers multiplied patients' weight/height with recommended drug dosage to obtain patients' drug units used for treatment assuming no dose reduction, and computed the discarded drug units by subtracting patients' treatment drug units from the full vial sizes.
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From page 135... ...
For these patients, the top 10 percent paid more than $380 for discarded drugs, whereas for patients not in high-deductible plans, the top 10 percent paid more than $260. THE JW MODIFIER COMPLIANCE RATE There was substantial variation in health care providers' use of the JW modifier from one drug to another, as shown in Figure B-3.
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From page 136... ...
Among this sample of health care providers, the percentage who never used the JW modifier varied across drugs, from 8 percent of health care providers administering brentuximab vedotin never using the modifier for that drug to 70 percent of those administering infliximab. Given the large percentages of physicians with more than 11 claims who used the modifier in some cases but not others, there is clear evidence that health care providers' use of the JW modifier is inconsistent from one drug to another.
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From page 137... ...
, the use of the JW modifier in urban versus rural areas did not follow any sort of consistent pattern. As shown in Figure B-7, the rates of JW modifier use were similar between health care providers with above median number of claims for a particular drug (dark blue bars)
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From page 138... ...
138 MEDICATIONS IN SINGLE-DOSE VIALS FIGURE B-5 Percentage of claims with the JW modifier for weight-based drugs with at least 1 percent of claims with the JW modifier by region, 2018. FIGURE B-6 Percentage of claims with the JW modifier for drugs with at least 1 percent of claims with the JW modifier in urban versus rural areas, 2018.
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From page 139... ...
APPENDIX B 139 FIGURE B-7 Percentage of claims with the JW modifier for top waste drugs, by provider volume, 2018. FIGURE B-8 Percentage of claims with the JW modifier for drugs with at least 1 percent of claims with the JW modifier by care setting, 2018.
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From page 140... ...
140 MEDICATIONS IN SINGLE-DOSE VIALS the sample with at least 1 percent of Medicare claims with the JW modifier, JW modifier use was higher in terms of the percentage of claims for a given drug with the JW modifier in physician office settings relative to hospital outpatient departments.
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