Potential Cost Savings in Medicare Part D for Otolaryngologic Medications

Om B. Tripathi; Aman M. Patel; Hassaam S. Choudhry; David W. Wassef; Paul T. Cowan; Richard Chan Woo Park; Andrey Filimonov

PMC · DOI:10.1007/s12070-025-05446-z·March 28, 2025

Potential Cost Savings in Medicare Part D for Otolaryngologic Medications

Om B. Tripathi, Aman M. Patel, Hassaam S. Choudhry, David W. Wassef, Paul T. Cowan, Richard Chan Woo Park, Andrey Filimonov

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TL;DR

This study explores cost savings and losses in Medicare Part D by comparing medication costs through a direct-to-consumer model for otolaryngology prescriptions.

Contribution

The study introduces a novel analysis of Medicare Part D cost efficiency using a direct-to-consumer drug procurement model for otolaryngologic medications.

Findings

01

45.3% of the top 75 otolaryngologic medications by spending were unavailable through MCCPDC.

02

Antibiotics consistently showed potential cost losses via MCCPDC procurement.

03

Direct-to-consumer models may offer savings for some medications but not others.

Abstract

Our study analyzes potential savings and losses for Medicare Part D using Mark Cuban Cost Plus Drug Company (MCCPDC) as an alternative medication procurement method for the 75 most commonly prescribed medications by otolaryngologists in 2022. Monthly standard MCCPDC costs and imputed Medicare Part D monthly costs for each prescription medication were compared. Our results indicated heterogenous efficiency of sourcing medications through MCCPDC due to some potential cost savings but other substantial losses. 45.3% of the top 75 otolaryngologic prescription medications sorted by total spending were not available on MCCPDC, indicating the need for more affordable access to expensive medications. Additionally, antibiotics consistently displayed potential losses through MCCPDC procurement, suggesting Medicare’s ability to achieve discount pricing for particular drug categories. Hence,…

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Keywords

Mark Cuban Cost Plus Drug CompanyMedicare Part DCost SavingsOtolaryngologyDrug Distribution

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TopicsHealth Systems, Economic Evaluations, Quality of Life · Pharmaceutical Economics and Policy · Economic and Financial Impacts of Cancer

Full text

Introduction

The Medicare Part D program is designed to help beneficiaries pay for prescription medications and control out-of-pocket expenses [1]. Due to intermediaries involved between manufacturers and consumers, prescription medications are often subject to significant price markups within distribution models despite having generic counterparts. This burden is heightened by restrictions on Medicare’s ability to negotiate drug prices and set preferred generic manufacturers, which increases monthly premiums and out-of-pocket (OOP) costs for Medicare beneficiaries [2]. In response, MCCPDC was created in January 2022 as a direct-to-consumer (DTC) company. Previous studies have shown Medicare overspending in comparison with DTC approaches, such as the Mark Cuban Cost Plus Drug Company (MCCPDC), that could save a minimum of $1.29 billion,$ 661.8 million, $64.5 million on urologic, oncologic, and ophthalmologic medications, respectively [2, 3, 4].

Methods

This study analyzes availability and potential savings if Medicare Part D sourced medications directly from MCCPDC for the 75 medications most commonly prescribed by otolaryngologists in 2022. We utilized data from the Center for Medicare and Medicaid Services (CMS) files and the MCCPDC website. Although numerous DTC models exist, we selected MCCPDC due to its relative newness to the market, making it attractive to investigate from a specialty-specific perspective, and its fixed cost-plus-pricing approach. Medications on MCCPDC are sold at a fixed 15% markup, $5 pharmacy service fee, and$ 5 shipping fee. Each form of the medication was reported individually, and quantity was held at the smallest count for each available form, either 1- or 30-count. Monthly standard cost was taken as an average of all strength variations. All brand name alternatives found on MCCPDC were included to provide consistency and account for off-label usage. Although every medication form was included within the tables, medications with multiple forms were excluded from our top 10 savings and losses categories in our results section to prevent inaccurate estimations due to unclear delineation of forms in the Medicare Part D database. Shipping costs set at $5 per order on the MCCPDC website were excluded from the final monthly value as their inclusion could overestimate total costs for customers ordering > 1 medication. To account for inflation, 2022 Medicare prices were adjusted to estimate 2024 prices using the National Average Drug Acquisition Cost data.

Results

Of the 75 medications prescribed by otolaryngologists with the most claims, 23 (30.7%) were not available on the MCCPDC website (Table 1). The 10 medications associated with the highest savings on MCCPDP were Azelastine HCL - Optivar ( $10,580,178.71), Azelastine HCL - Astelin ($ 9,925,397.15), Fluticasone Propionate – Flonase ( $5,692,152.58), Mometasone Furoate – Nasonex ($ 1,213,744.20), Tobramycin/Dexamethasone ( $706,543.95), Azelastine/Fluticasone ($ 703,066.54), Cefdinir ( $561,403.80), Pilocarpine HCL – Salagen ($ 514,365.97), Esomeprazole Magnesium ( $458,072.68), Doxycycline Hyclate – Lymepak ($ 437,875.68). If the ten listed medications were purchased from MCCPDC, estimated annual costs would be 47.7% of total expenditure by Medicare Part D, totaling $30,334,728.58 in potential monthly savings.

Table 1. Savings profile for the top 75 otolaryngology medications by total 2022 prescription fillsMedicationDose (Strength: Volume)FormTotal 2022 Medicare Part D SpendingTotal 2022 30-Day Prescriptions in Medicare Part DImputed Monthly Costs for Medicare Part D ( $)Monthly Standard MCCPDC ($ )Potential Savings ($)Fluticasone Propionate (Flonase)50mcg:16mLNasal Spray17,543,104.211,136,158.2015.4510.445,692,152.58Fluticasone Propionate (Cutivate)0.005%:15 gTube of Ointment17,543,104.211,136,158.2015.4510.875,203,604.56Fluticasone Propionate (Cutivate)0.05%:60mLBottle of Lotion17,543,104.211,136,158.2015.45128.65(128,613,108.24)Fluticasone Propionate (Cutivate)0.05%:60 gCream17,543,104.211,136,158.2015.4520.18(5,374,028.29)Fluticasone Propionate (Cutivate)0.005%:60gmOintment17,543,104.211,136,158.2015.4529.71(16,201,615.93)Azelastine Hcl (Astelin)0.1%:30mLNasal Spray15,635,459.03545,651.3028.6610.479,925,397.15Azelastine Hcl (Optivar)0.05%:6mLSolution15,635,459.03545,651.3028.669.2710,580,178.71Ipratropium Bromide0.02%:30 × 2.5mLVial of Solution16,796,060.76520,094.3032.314.589,216,071.00Ipratropium Bromide0.06%:15mLNasal Spray16,796,060.76520,094.3032.320.536,121,509.91Ipratropium Bromide0.03%:30mLNasal Spray16,796,060.76520,094.3032.320.536,121,509.91Omeprazole20 mgDelayed Release Capsule3,455,167.27482,381.707.176.35395,552.99Famotidine10 mg, 20 mg, 40 mgTablet3,264,958.02444,454.807.356.20511,123.02Famotidine40 mg / 5mL:50mLSuspension 50mL3,264,958.02444,454.807.3525.70(8,155,745.58)Montelukast Sodium10 mgTablet3,222,638.37432,946.807.456.20541,183.50Montelukast Sodium4 mgPacket3,222,638.37432,946.807.4534.10(11,538,032.22)Montelukast Sodium4 mg, 5 mgPacket3,222,638.37432,946.807.456.80281,415.42Prednisone5 mg:21 Tablets, 10 mg:48 TabletsTablet Therapy Pack767,596.02154,360.004.9813.85(1,369,173.20)Prednisone1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mgTablet767,596.02154,360.004.987.60(404,423.20)Prednisone5 mg/5mL:120mLBottle of Solution767,596.02154,360.004.9885.10(12,367,323.20)Mupirocin2%:22 gOintment1,387,342.74130,041.4010.677.25444,741.59Mupirocin2%:15 g,30 gCream1,387,342.74130,041.4010.6719.54(1,153,467.22)Amoxicillin/Potassium Clav1000-62.5 mgExtended Release Tablet1,906,399.91123,787.6015.41206.00(23,592,678.68)Pantoprazole Sodium--1,617,809.41208,988.607.75--Methylprednisolone4 mg:21 packBlister Pack of 21 Tablets918,420.0098,303.809.357.74158,269.12Methylprednisolone4 mg, 8 mg, 16 mg, 32 mgTablet918,420.0098,303.809.3542.28(3,237,144.13)Ofloxacin (Floxin)300 mg, 400 mgTablet4,777,483.4495,881.7049.83380.30(31,686,025.40)Ofloxacin (Ocuflox)0.3%:5mLOphthalmic Solution − 5mL4,777,483.4495,881.7049.8314.113,424,894.32Ofloxacin (Ocuflox)0.3%:10mLOphthalmic Solution − 10mL4,777,483.4495,881.7049.8315.303,310,795.10Mometasone Furoate (Nasonex)50mcg:17 gSuspension3,467,521.3472,203.7048.0331.221,213,744.20Mometasone Furoate (Elocon)0.10%:45 gCream3,467,521.3472,203.7048.0314.152,446,261.36Mometasone Furoate (Elocon)0.10%:45 gOintment3,467,521.3472,203.7048.0318.702,117,734.52Varicella-Zoster Ge/As01b/Pf--16,061,601.0083,030.00193.45--Hydrocodone/Acetaminophen--609,375.5873,699.008.27--Levocetirizine Dihydrochloride5 mgTablet1,208,263.83127,773.909.466.50378,210.74Levocetirizine Dihydrochloride2.5 mg/5mL:148mLSolution1,208,263.83127,773.909.4623.74(1,824,611.29)Levothyroxine Sodium25mcg, 75mcg, 100mcg, 137mcg, 150mcgTablet1,549,498.17144,863.5010.710.1875,329.02Azithromycin250 mg, 500 mg, 600 mgTablet402,942.3549,306.208.1816.80(425,019.44)Ciprofloxacin Hcl/Dexameth--8,082,874.3249,249.10164.13--Cephalexin (Keflex)250 mg, 500 mg, 750 mgCapsule340,962.7245,353.407.5286.20(3,568,405.51)Cephalexin (Keftab)250 mgTablet340,962.7245,353.407.5235.60(1,273,523.47)Fluocinolone Acetonide Oil--3,135,136.1953,615.8058.48--Doxycycline Hyclate (Doryx)50 mg, 75 mg, 100 mg, 150 mg, 200 mgTablet Delayed Release886,088.4043,098.0020.5654.82(1,476,537.48)Doxycycline Hyclate (TargaDOX)50 mgTablet886,088.4043,098.0020.56166.40(6,285,412.32)Doxycycline Hyclate (Acticlate)75 mg, 150 mgTablet886,088.4043,098.0020.5617.60127,570.08Doxycycline Hyclate (Lymepak)100 mgTablet886,088.4043,098.0020.5610.40437,875.68Doxycycline Hyclate (Vibramycin)20 mgTablet886,088.4043,098.0020.568.90502,522.68Doxycycline Hyclate (Vibramycin)50 mg, 100 mgCapsule886,088.4043,098.0020.569.50476,663.88Cefdinir300 mgCapsule1,091,097.5842,402.1025.7412.50561,403.80Neomycin/Polymyxin B/Hydrocort3.5 mg/mL 10,000 unit/mL 1%:10mLSuspension2,425,096.9238,527.6062.9541.40830,269.78Neomycin/Polymyxin B/Hydrocort3.5-10000-1:7.5mLSolution Dropper2,425,096.9238,527.6062.95154.25(3,517,569.88)Neomycin/Polymyxin B/Hydrocort1%:10mLSolution2,425,096.9238,527.6062.9556.11263,528.78Ciprofloxacin Hcl--363,024.8030,158.5012.04--Triamterene/Hydrochlorothiazid37.5-25 mgCapsule300,703.9359,900.705.036.80(106,024.24)Amoxicillin250 mg, 500 mgCapsule136,005.8024,617.105.537.10(38,648.85)Amoxicillin500 mg, 875 mgTablet136,005.8024,617.105.537.85(57,111.67)Amoxicillin125 mg, 250 mgTablet Chewable136,005.8024,617.105.5313.85(204,814.27)Triamcinolone Acetonide (Oralone)0.1%:5 gPaste489,660.9124,861.6019.720.78(26,850.53)Triamcinolone Acetonide (Trianex)0.05%:430 gJar of Ointment489,660.9124,861.6019.786.75(1,666,970.28)Triamcinolone Acetonide (Aristocort A)0.1%:15 g,454 g,80 gOintment489,660.9124,861.6019.712.22185,964.77Triamcinolone Acetonide (Aristocort A)0.025%:15 g,454 g,80 gCream489,660.9124,861.6019.713.33158,368.39Triamcinolone Acetonide (Triderm)0.1%:15 g,30 g,454 g,80 g, 0.5%:15 gCream489,660.9124,861.6019.710.22235,687.97Triamcinolone Acetonide (Kenalog)0.025%:15 gTube of Ointment489,660.9124,861.6019.77.75297,096.12Triamcinolone Acetonide (Kenalog)0.147 mg/gm:100 gBottle of Solution Spray489,660.9124,861.6019.7147.32(3,172,837.39)Triamcinolone Acetonide (Kenalog)0.1%:60mL, 0.025%:60mLLotion489,660.9124,861.6019.721.69(49,474.58)Gabapentin--338,506.6430,735.7011.02--Sulfamethoxazole/Trimethoprim (Bactrim)400-80 mg, 800-160 mgTablet147,245.0223,256.506.346.35(232.56)Sulfamethoxazole/Trimethoprim (Sulfatrim)200-40 mg/5mL:473mLBottle of Suspension147,245.0223,256.506.3428.11(506,294.01)Cefuroxime Axetil250 mg, 500 mgTablet681,189.5322,606.1030.1412.20405,553.43Meclizine Hcl (Travel-Ease)25 mgTablet201,888.9822,085.409.155.9071,777.55Meclizine Hcl (Antivert)12.5 mgTablet201,888.9822,085.409.156.5058,526.31Clindamycin Hcl75 mg, 150 mg, 300 mgCapsule238,867.5919,131.8012.4910.6036,159.10Clindamycin Hcl75 mg/5mL:100mLSolution238,867.5919,131.8012.4914.78(43,811.82)Clindamycin Hcl2%:40 gTube of Cream238,867.5919,131.8012.4958.36(877,575.67)Diazepam--71,304.4118,538.903.85--Oxycodone Hcl--238,487.9517,106.0013.95--Nystatin (Nystop)100,000 unit/g:60 gPowder416,308.0416,329.7025.516.56145,987.52Nystatin (Nystex)100,000 unit/g:30 gOintment416,308.0416,329.7025.59.67258,499.15Nystatin (Mycostatin)100,000 unit/mL:60mLBottle of Suspension416,308.0416,329.7025.59.23265,684.22Nystatin (Mycostatin)100,000 unit/g:15 gCream416,308.0416,329.7025.57.78289,362.28Nystatin (Mycostatin)500,000 unitTablet416,308.0416,329.7025.512.20217,185.01Levofloxacin250 mg, 500 mg, 750 mgTablet158,952.1014,889.3010.6812.40(25,609.60)Levofloxacin25 mg/mL:200mLBottle of Solution158,952.1014,889.3010.68403.91(5,854,919.44)Oxycodone Hcl/Acetaminophen--120,436.1814,465.008.33--Ondansetron (Zofran ODT)4 mgODT Tablet161,994.7414,311.8011.3210.708,873.32Ondansetron (Zofran)4 mg, 8 mgTablet161,994.7414,311.8011.327.4056,102.26Ondansetron (Zofran)4 mg/5mL:50mLBottle of Solution161,994.7414,311.8011.3214.41(44,223.46)Fluconazole50 mg, 100 mg, 150 mg, 200 mgTablet255,304.7214,474.2017.6411.6087,424.17Doxycycline Monohydrate (Monodox)50 mg, 100 mgCapsule247,693.1711,896.4020.837.85154,415.27Doxycycline Monohydrate (Adoxa Pak 1/150)150 mgTablet247,693.1711,896.4020.8313.7084,821.33Doxycycline Monohydrate (Vibramycin Monohydrate)25 mg/5mL:60mLBottle of Suspension247,693.1711,896.4020.8317.3141,875.33Doxycycline Monohydrate (Adoxa)50 mg, 75 mg, 100 mgTablet247,693.1711,896.4020.8311.10115,751.97Doxycycline Monohydrate (Adoxa)150 mgCapsule247,693.1711,896.4020.8343.40(268,501.75)Clotrimazole/Betamethasone Dip1%-0.05%Cream281,205.1011,929.6023.5812.27134,923.78Clotrimazole/Betamethasone Dip1%-0.05%Bottle of Lotion281,205.1011,929.6023.5860.38(439,009.28)Epinephrine--3,053,846.0312,327.80247.73--Diphth, pertuss(Acell), tet Vac--684,358.1210,911.0062.73--Amitriptyline Hcl10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mgTablet123,441.3915,336.208.058.00766.81Nortriptyline Hcl10 mg, 25 mg, 50 mg, 75 mgCapsule158,999.3116,519.109.637.1840,471.80Tobramycin/Dexamethasone0.3 − 0.1%Suspension Dropper980,458.6210,021.9097.8427.34706,543.95Clotrimazole (Mycelex)1%:30mLBottle of Solution442,987.9110,478.4042.2816.16273,695.81Clotrimazole (Mycelex)10 mgLozenge442,987.9110,478.4042.2814.90286,898.59Clotrimazole (Lotrimin AF)1%:28.4 gCream442,987.9110,478.4042.286.50374,917.15Clotrimazole (Gyne-Lotrimin)1%:45 gVaginal Cream442,987.9110,478.4042.288.40355,008.19Tramadol Hcl--47,465.159,975.504.76--Chlorhexidine Gluconate0.12%:473mLBottle of Solution61,006.6310,010.106.17.11(10,110.20)Esomeprazole Magnesium20 mgDelayed Release Tablet665,796.3516,232.2041.0212.80458,072.68Azelastine/Fluticasone137-50mcg/Act:23 gNasal Spray1,426,466.3210,293.80138.5870.28703,066.54Pilocarpine Hcl (Salagen)5 mg, 7.5 mgTablet663,132.7312,508.9053.0211.90514,365.97Pilocarpine Hcl (Isoto Carpine)4%:15mL, 2%:15mL, 1%:15mLBottle of Solution663,132.7312,508.9053.0231.65267,315.19Dexamethasone Sodium Phosphate--409,779.698,374.4048.94--Prednisolone Acetate--459,479.428,714.3052.73--Alprazolam--52,225.207,709.906.78--Hydrochlorothiazide12.5 mg, 25 mg, 50 mgTablet33,529.0815,378.402.196.10(60,129.54)Hydrochlorothiazide12.5 mgCapsule33,529.0815,378.402.196.20(61,667.38)Dexamethasone (Dexpak)1.5 mg:21 Tablets6-day Dose Pack151,627.118,253.9018.38144.76(1,043,127.88)Dexamethasone (Dexpak)1.5 mg:51 Tablets13-day Dose Pack151,627.118,253.9018.38339.21(2,648,098.74)Dexamethasone (Dexpak)1.5 mg:35 Tablets10-day Dose Pack151,627.118,253.9018.38237.97(1,812,473.90)Dexamethasone (Decadron)0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mgTablet151,627.118,253.9018.3813.4940,361.57Dexamethasone (Decadron)0.5 mg/5mL:237mLBottle of Elixir151,627.118,253.9018.3816.7713,288.78Dexamethasone (Decadron)0.5 mg/5mL:500mLBottle of Solution151,627.118,253.9018.3820.64(18,653.81)Dexamethasone (Decadron)0.1%:5mLSolution Dropper151,627.118,253.9018.3843.60(208,163.36)Acetaminophen With Codeine--40,507.196,505.006.23--Clonazepam--57,538.527,901.307.29--Dupilumab--22,264,185.906,408.003474.44--Promethazine Hcl12.5 mg, 25 mg, 50 mgTablet33,658.256,492.205.196.35(7,530.95)Promethazine Hcl12.5 mg:12 SuppositoriesPack of Suppositories33,658.256,492.205.1926.73(139,841.99)Promethazine Hcl6.25 mg/5mL:473mLBottle of Syrup33,658.256,492.205.1920.92(102,122.31)Valacyclovir Hcl--373,840.617,823.3047.79--Albuterol Sulfate (AccuNeb)0.63 mg/3mL: Box of 25 VialsNebulization Solution266,843.606,806.7039.2125.5792,843.39Albuterol Sulfate (AccuNeb)1.25 mg/3mL:75mLPack of Inhalation Suspension Vials266,843.606,806.7039.2117.54147,501.19Albuterol Sulfate (Proventil)2.5 mg/0.5mL: Box of 30 VialsNebulization Solution266,843.606,806.7039.2120.10130,076.04Albuterol Sulfate (Proventil)2 mg/5mL:473mLBottle of Syrup266,843.606,806.7039.2117.80145,731.45Albuterol Sulfate (Proventil)90mcg:6.7 gInhaler266,843.606,806.7039.2117.30149,134.80Albuterol Sulfate (Proventil)0.083%:90mLPack of Nebulization Solution Vials266,843.606,806.7039.2112.76180,037.22Albuterol Sulfate (Proventil)2 mg, 4 mgTablet266,843.606,806.7039.2110.10198,143.04Lorazepam--23,369.886,092.103.84--Ondansetron Hcl--45,175.025,281.808.56--Ibuprofen200 mg, 400 mg, 600 mg, 800 mgTablet38,191.715,351.307.146.055,832.92Ibuprofen100 mg/5mL:118mLBottle of Suspension38,191.715,351.307.147.89(4,013.48)Meloxicam (Vivlodex)7.5 mg, 15 mgTablet25,364.245,992.704.245.75(9,048.98)Meloxicam (Mobic)5 mg, 10 mgCapsule25,364.245,992.704.24273.95(1,616,291.12)Clarithromycin250 mg, 500 mgTablet159,620.344,905.5032.5414.6088,004.67Sodium Chloride Irrig Solution--111,916.755,070.9022.08--Lansoprazole15 mg, 30 mgDelayed Release Capsule213,869.348,186.5026.139.05139,825.42Olopatadine Hcl (Patanase)0.6%:30.5 gSolution Spray460,689.546,193.8074.3819.60339,296.36Olopatadine Hcl (Pataday)0.1%;5mLOphthalmic Solution460,689.546,193.8074.3810.43396,093.51Betamethasone Valerate (Luxiq)0.12%:50 gCan of Foam100,706.694,006.8025.1427.30(8,654.69)Betamethasone Valerate (Betatrex)0.1%:15 gTube of Ointment100,706.694,006.8025.1413.6146,198.40Betamethasone Valerate (Beta-Val)0.1%:15 gTube of Cream100,706.694,006.8025.148.0268,596.42Betamethasone Valerate (Beta-Val)0.1%:45 gCream100,706.694,006.8025.1416.2435,660.52Betamethasone Valerate (Beta-Val)0.1%:60mLBottle of Lotion100,706.694,006.8025.1427.40(9,055.37)Acetic Acid2%:15mLBottle of Solution88,135.924,059.7021.7117.6116,644.77Acyclovir200 mgCapsule108,662.825,551.9019.586.8070,953.28Acyclovir5%:15 g,30 gOintment108,662.825,551.9019.588.2263,069.58Acyclovir200 mg/5mL:473mLSuspension 473mL108,662.825,551.9019.5878.82(328,894.56)Acyclovir400 mg, 800 mgTablet108,662.825,551.9019.588.0064,291.00Acyclovir5%:5 gTube of Cream108,662.825,551.9019.5870.81(284,423.84)

The 10 medications associated with the highest losses were Ofloxacin – Floxin ( $31,686,025.40), Amoxicillin/Potassium Clavulanate ($ 23,592,678.68), Doxycycline Hyclate – TargaDOX ( $6,285,412.32), Cephalexin – Keflex ($ 3,568,405.51), Triamcinolone Acetonide – Trianex ( $1,666,970.28), Meloxicam – Mobic ($ 1,616,291.12), Doxycycline Hyclate – Doryx ( $1,476,537.48), Cephalexin – Keftab ($ 1,273,523.47), Sulfamethoxazole/Trimethoprim – Sulfatrim ( $506,294.01), Azithromycin ($ 425,019.44). If MCCPDC was used by Medicare Part D as the source of prescription medications, estimated monthly government overspending on these listed medications would total $72,097,157.71.

When sorting prescriptions by highest monthly expenditure, 34 (45.3%) were not available on the MCCPDC website (Table 2). 27 (36%) new medications were included and compared to Table 1. The 10 medications associated with the highest savings on MCCPDP were Azelastine HCL – Optivar ( $10,580,178.71), Azelastine HCL – Astelin ($ 9,925,397.15), Fluticasone Propionate – Flonase ( $5,692,152.58), Mometasone Furoate – Nasonex ($ 1,213,744.20), Dexlansoprazole ( $777,480.61), Tobramycin/Dexamethasone ($ 706,543.95), Azelastine/Fluticasone ( $703,066.54), Budesonide – Pulmicort Respules ($ 655,191.43), Cefdinir ( $561,403.80), Pilocarpine HCL – Salagen ($ 514,365.97). If the ten listed medications were purchased from MCCPDC, estimated annual costs would be 46.8% of total expenditure by Medicare Part D, totaling $31,329,524.94 in potential monthly savings.

Table 2. Savings profile for the top 75 otolaryngology medications by total 2022 medicare part D spendingMedicationDose (Strength: Volume)FormTotal 2022 Medicare Part D SpendingTotal 2022 30-Day Prescriptions in Medicare Part DImputed Monthly Costs for Medicare Part D ( $)Monthly Standard MCCPDC ($ )Potential Savings ($)Dupilumab--22,264,185.906,408.003474.44--Fluticasone Propionate (Flonase)50mcg:16mLNasal Spray17,543,104.211,136,158.2015.4510.445,692,152.58Fluticasone Propionate (Cutivate)0.005%:15 gTube of Ointment17,543,104.211,136,158.2015.4510.875,203,604.56Fluticasone Propionate (Cutivate)0.05%:60mLBottle of Lotion17,543,104.211,136,158.2015.45128.65(128,613,108.24)Fluticasone Propionate (Cutivate)0.05%:60 gCream17,543,104.211,136,158.2015.4520.18(5,374,028.29)Fluticasone Propionate (Cutivate)0.005%:60gmOintment17,543,104.211,136,158.2015.4529.71(16,201,615.93)Ipratropium Bromide0.02%:30 × 2.5mLVial of Solution16,796,060.76520,094.3032.314.589,216,071.00Ipratropium Bromide0.06%:15mLNasal Spray16,796,060.76520,094.3032.320.536,121,509.91Ipratropium Bromide0.03%:30mLNasal Spray16,796,060.76520,094.3032.320.536,121,509.91Varicella-Zoster Ge/As01b/Pf--16,061,601.0083,030.00193.45--Azelastine Hcl (Astelin)0.1%:30mLNasal Spray15,635,459.03545,651.3028.6610.479,925,397.15Azelastine Hcl (Optivar)0.05%:6mLSolution15,635,459.03545,651.3028.669.2710,580,178.71Ciprofloxacin Hcl/Dexameth--8,082,874.3249,249.10164.13--Ofloxacin (Floxin)300 mg, 400 mgTablet4,777,483.4495,881.7049.83380.30(31,686,025.40)Ofloxacin (Ocuflox)0.3%:5mLOphthalmic Solution − 5mL4,777,483.4495,881.7049.8314.113,424,894.32Ofloxacin (Ocuflox)0.3%:10mLOphthalmic Solution − 10mL4,777,483.4495,881.7049.8315.303,310,795.10Mometasone Furoate (Nasonex)50mcg:17 gSuspension3,467,521.3472,203.7048.0331.221,213,744.20Mometasone Furoate (Elocon)0.10%:45 gCream3,467,521.3472,203.7048.0314.152,446,261.36Mometasone Furoate (Elocon)0.10%:45 gOintment3,467,521.3472,203.7048.0318.702,117,734.52Omeprazole20 mgDelayed Release Capsule3,455,167.27482,381.707.176.35395,552.99Famotidine10 mg, 20 mg, 40 mgTablet3,264,958.02444,454.807.356.20511,123.02Famotidine40 mg / 5mL:50mLSuspension 50mL3,264,958.02444,454.807.3525.70(8,155,745.58)Montelukast Sodium10 mgTablet3,222,638.37432,946.807.456.20541,183.50Montelukast Sodium4 mgPacket3,222,638.37432,946.807.4534.10(11,538,032.22)Montelukast Sodium4 mg, 5 mgPacket3,222,638.37432,946.807.456.80281,415.42Fluocinolone Acetonide Oil--3,135,136.1953,615.8058.48--Epinephrine--3,053,846.0312,327.80247.73--Neomycin/Polymyxin B/Hydrocort3.5 mg/mL 10,000 unit/mL 1%:10mLSuspension2,425,096.9238,527.6062.9541.40830,269.78Neomycin/Polymyxin B/Hydrocort3.5-10000-1:7.5mLSolution Dropper2,425,096.9238,527.6062.95154.25(3,517,569.88)Neomycin/Polymyxin B/Hydrocort1%:10mLSolution2,425,096.9238,527.6062.9556.11263,528.78Amoxicillin/Potassium Clav1000-62.5 mgExtended Release Tablet1,906,399.91123,787.6015.41206.00(23,592,678.68)Dexlansoprazole30 mg, 60 mgCapsule Delayed Release1,618,125.155,265.70307.3159.65777,480.61Pantoprazole Sodium--1,617,809.41208,988.607.75--Levothyroxine Sodium25mcg, 75mcg, 100mcg, 137mcg, 150mcgTablet1,549,498.17144,863.5010.710.1875,329.02Sodium, calcium, mag, pot Oxybate--1,532,278.16100.0015322.79--Azelastine/Fluticasone137-50mcg/Act:23 gNasal Spray1,426,466.3210,293.80138.5870.28703,066.54Sodium Oxybate--1,403,344.4673.0019223.9--Mupirocin2%:22 gOintment1,387,342.74130,041.4010.677.25444,741.59Mupirocin2%:15 g,30 gCream1,387,342.74130,041.4010.6719.54(1,153,467.22)Levocetirizine Dihydrochloride5 mgTablet1,208,263.83127,773.909.466.50378,210.74Levocetirizine Dihydrochloride2.5 mg/5mL:148mLSolution1,208,263.83127,773.909.4623.74(1,824,611.29)Mepolizumab--1,182,545.35310.403809.75--Omalizumab--1,126,986.27392.802869.11--Cefdinir300 mgCapsule1,091,097.5842,402.1025.7412.50561,403.80Tobramycin/Dexamethasone0.3 − 0.1%Suspension Dropper980,458.6210,021.9097.8427.34706,543.95Methylprednisolone4 mg:21 packBlister Pack of 21 Tablets918,420.0098,303.809.357.74158,269.12Methylprednisolone4 mg, 8 mg, 16 mg, 32 mgTablet918,420.0098,303.809.3542.28(3,237,144.13)Doxycycline Hyclate (Doryx)50 mg, 75 mg, 100 mg, 150 mg, 200 mgTablet Delayed Release886,088.4043,098.0020.5654.82(1,476,537.48)Doxycycline Hyclate (TargaDOX)50 mgTablet886,088.4043,098.0020.56166.40(6,285,412.32)Doxycycline Hyclate (Acticlate)75 mg, 150 mgTablet886,088.4043,098.0020.5617.60127,570.08Doxycycline Hyclate (Lymepak)100 mgTablet886,088.4043,098.0020.5610.40437,875.68Doxycycline Hyclate (Vibramycin)20 mgTablet886,088.4043,098.0020.568.90502,522.68Doxycycline Hyclate (Vibramycin)50 mg, 100 mgCapsule886,088.4043,098.0020.569.50476,663.88Budesonide/Formoterol Fumarate80-4.5mcg/Act:10.2 g Inhaler, 160-4.5mcg/Act:10.2 g InhalerAerosol Inhaler866,512.602,360.00367.17194.50407,501.20Budesonide (Pulmicort)1 mg/2mL:30 AmpulesCarton of Ampules834,711.055,457.20152.96168.82(86,551.19)Budesonide (Uceris)2 mg:2 CansPack of Foam Canisters834,711.055,457.20152.96623.35(2,567,012.31)Budesonide (Uceris)9 mgTablet Extended Release834,711.055,457.20152.96416.00(1,435,461.89)Budesonide (Pulmicort Respules)0.25 mg/2mL:60mL (30 × 2mL), 0.5 mg/2mL:60mL (30 × 2mL)Box of 30 Vials834,711.055,457.20152.9632.90655,191.43Fluticasone/Vilanterol--767,675.451,973.00389.1--Prednisone5 mg:21 Tablets, 10 mg:48 TabletsTablet Therapy Pack767,596.02154,360.004.9813.85(1,369,173.20)Prednisone1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mgTablet767,596.02154,360.004.987.60(404,423.20)Prednisone5 mg/5mL:120mLBottle of Solution767,596.02154,360.004.9885.10(12,367,323.20)Fluticasone/Umeclidin/Vilanter--758,154.261,189.00637.65--Diphth, pertuss(Acell), tet Vac--684,358.1210,911.0062.73--Chenodiol--682,914.9612.0056909.58--Cefuroxime Axetil250 mg, 500 mgTablet681,189.5322,606.1030.1412.20405,553.43Esomeprazole Magnesium20 mgDelayed Release Tablet665,796.3516,232.2041.0212.80458,072.68Pilocarpine Hcl (Salagen)5 mg, 7.5 mgTablet663,132.7312,508.9053.0211.90514,365.97Pilocarpine Hcl (Isoto Carpine)4%:15mL, 2%:15mL, 1%:15mLBottle of Solution663,132.7312,508.9053.0231.65267,315.19Adalimumab--647,633.9893.006963.81--Lanadelumab-Flyo--636,114.4413.0048931.88--Hydrocodone/Acetaminophen--609,375.5873,699.008.27--Fluticasone Propion/Salmeterol--566,504.031,804.00314.03--Immun Glob G(Igg)/Pro/Iga 0–50--507,687.4248.0010576.83--Triamcinolone Acetonide (Oralone)0.1%:5 gPaste489,660.9124,861.6019.720.78(26,850.53)Triamcinolone Acetonide (Trianex)0.05%:430 gJar of Ointment489,660.9124,861.6019.786.75(1,666,970.28)Triamcinolone Acetonide (Aristocort A)0.1%:15 g,454 g,80 gOintment489,660.9124,861.6019.712.22185,964.77Triamcinolone Acetonide (Aristocort A)0.025%:15 g,454 g,80 gCream489,660.9124,861.6019.713.33158,368.39Triamcinolone Acetonide (Triderm)0.1%:15 g,30 g,454 g,80 g, 0.5%:15 gCream489,660.9124,861.6019.710.22235,687.97Triamcinolone Acetonide (Kenalog)0.025%:15 gTube of Ointment489,660.9124,861.6019.77.75297,096.12Triamcinolone Acetonide (Kenalog)0.147 mg/gm:100 gBottle of Solution Spray489,660.9124,861.6019.7147.32(3,172,837.39)Triamcinolone Acetonide (Kenalog)0.1%:60mL, 0.025%:60mLLotion489,660.9124,861.6019.721.69(49,474.58)Olopatadine Hcl (Patanase)0.6%:30.5 gSolution Spray460,689.546,193.8074.3819.60339,296.36Olopatadine Hcl (Pataday)0.1%;5mLOphthalmic Solution460,689.546,193.8074.3810.43396,093.51Prednisolone Acetate--459,479.428,714.3052.73--Clotrimazole (Mycelex)1%:30mLBottle of Solution442,987.9110,478.4042.2816.16273,695.81Clotrimazole (Mycelex)10 mgLozenge442,987.9110,478.4042.2814.90286,898.59Clotrimazole (Lotrimin AF)1%:28.4 gCream442,987.9110,478.4042.286.50374,917.15Clotrimazole (Gyne-Lotrimin)1%:45 gVaginal Cream442,987.9110,478.4042.288.40355,008.19Nystatin (Nystop)100,000 unit/g:60 gPowder416,308.0416,329.7025.516.56145,987.52Nystatin (Nystex)100,000 unit/g:30 gOintment416,308.0416,329.7025.59.67258,499.15Nystatin (Mycostatin)100,000 unit/mL:60mLBottle of Suspension416,308.0416,329.7025.59.23265,684.22Nystatin (Mycostatin)100,000 unit/g:15 gCream416,308.0416,329.7025.57.78289,362.28Nystatin (Mycostatin)500,000 unitTablet416,308.0416,329.7025.512.20217,185.01Dexamethasone Sodium Phosphate--409,779.698,374.4048.94--Azithromycin250 mg, 500 mg, 600 mgTablet402,942.3549,306.208.1816.80(425,019.44)Apremilast--381,589.9884.004542.74--Valacyclovir Hcl--373,840.617,823.3047.79--Ciprofloxacin Hcl--363,024.8030,158.5012.04--Cevimeline Hcl30 mg:100 CapsulesBottle of Capsules355,916.922,725.80130.5853.30210,649.82Hydrocortisone/Acetic Acid1–2%:10mLSolution Dropper346,689.083,321.50104.3896.7525,343.05Cephalexin (Keflex)250 mg, 500 mg, 750 mgCapsule340,962.7245,353.407.5286.20(3,568,405.51)Cephalexin (Keftab)250 mgTablet340,962.7245,353.407.5235.60(1,273,523.47)Gabapentin--338,506.6430,735.7011.02--Tasimelteon20 mgCapsule317,452.8612.0026454.4113610.00154,132.92Vismodegib--315,412.4124.0013142.19--Triamterene/Hydrochlorothiazid37.5-25 mgCapsule300,703.9359,900.705.036.80(106,024.24)Guselkumab--293,086.1640.607218.88--Ustekinumab--291,717.0536.408014.21--Clotrimazole/Betamethasone Dip1%-0.05%Cream281,205.1011,929.6023.5812.27134,923.78Clotrimazole/Betamethasone Dip1%-0.05%Bottle of Lotion281,205.1011,929.6023.5860.38(439,009.28)Albuterol Sulfate (AccuNeb)0.63 mg/3mL: Box of 25 VialsNebulization Solution266,843.606,806.7039.2125.5792,843.39Albuterol Sulfate (AccuNeb)1.25 mg/3mL:75mLPack of Inhalation Suspension Vials266,843.606,806.7039.2117.54147,501.19Albuterol Sulfate (Proventil)2.5 mg/0.5mL: Box of 30 VialsNebulization Solution266,843.606,806.7039.2120.10130,076.04Albuterol Sulfate (Proventil)2 mg/5mL:473mLBottle of Syrup266,843.606,806.7039.2117.80145,731.45Albuterol Sulfate (Proventil)90mcg:6.7 gInhaler266,843.606,806.7039.2117.30149,134.80Albuterol Sulfate (Proventil)0.083%:90mLPack of Nebulization Solution Vials266,843.606,806.7039.2112.76180,037.22Albuterol Sulfate (Proventil)2 mg, 4 mgTablet266,843.606,806.7039.2110.10198,143.04Semaglutide--262,510.98291.10901.79--Cyclosporine (Restasis)0.05%:12mL (30 × 0.4mL)Box of 30 Vials (Emulsion)260,764.59786.30331.6469.40206,199.31Cyclosporine (Restasis)0.05%:24mL (60 × 0.4mL)Box of 60 Vials (Emulsion)260,764.59786.30331.64130.35158,274.33Cyclosporine (Sandimmune)25 mg:30 Capsules, 100 mg:30 CapsulesBottle of Capsules260,764.59786.30331.64226.0583,025.42Buprenorphine Hcl/Naloxone Hcl--256,580.20770.80332.88--Fluconazole50 mg, 100 mg, 150 mg, 200 mgTablet255,304.7214,474.2017.6411.6087,424.17Beclomethasone Dipropionate--252,690.75931.00271.42--Doxycycline Monohydrate (Monodox)50 mg, 100 mgCapsule247,693.1711,896.4020.837.85154,415.27Doxycycline Monohydrate (Adoxa Pak 1/150)150 mgTablet247,693.1711,896.4020.8313.7084,821.33Doxycycline Monohydrate (Vibramycin Monohydrate)25 mg/5mL:60mLBottle of Suspension247,693.1711,896.4020.8317.3141,875.33Doxycycline Monohydrate (Adoxa)50 mg, 75 mg, 100 mgTablet247,693.1711,896.4020.8311.10115,751.97Doxycycline Monohydrate (Adoxa)150 mgCapsule247,693.1711,896.4020.8343.40(268,501.75)Clindamycin Hcl75 mg, 150 mg, 300 mgCapsule238,867.5919,131.8012.4910.6036,159.10Clindamycin Hcl75 mg/5mL:100mLSolution238,867.5919,131.8012.4914.78(43,811.82)Clindamycin Hcl2%:40 gTube of Cream238,867.5919,131.8012.4958.36(877,575.67)Oxycodone Hcl--238,487.9517,106.0013.95--Secukinumab--232,680.5232.007271.27--Apixaban--219,968.32560.30392.6--

Using the same parameters, the 10 medications associated with the highest losses were Ofloxacin – Floxin ( $31,686,025.40), Amoxicillin/Potassium Clavulanate ($ 23,592,678.68), Doxycycline Hyclate – TargaDOX ( $6,285,412.32), Cephalexin – Keflex ($ 3,568,405.51), Triamcinolone Acetonide – Trianex ( $1,666,970.28), Doxycycline Hyclate – Doryx ($ 1,476,537.48), Cephalexin – Keftab ( $1,273,523.47), Azithromycin ($ 425,019.44), Triamterene/Hydrochlorothiazide ( $106,024.24), Budesonide – Pulmicort ($ 86,551.19). If MCCPDC was used by Medicare Part D as the direct source of prescription medications, estimated government overspending on these listed medications would total $70,167,148.01 monthly.

Discussion

Exploring alternatives to CMS traditional routes is important for reducing federal spending and beneficiary premiums [5]. This is particularly impactful for the field of otolaryngology, as previous research has already shown high markups for certain otolaryngologic services [6]. The contrasting results of potential savings and losses, heavily dependent on the medication, indicate both significant opportunities for cost savings and notable risks of overspending under blanket MCCPDC procurement. This aligns with previous medication-saving evaluations for direct-to-consumer models that imply the efficiency of MCCPDC to be heterogeneous, suggesting that a one-size-fits-all strategy may not be optimal [7].

Of the top 75 otolaryngologic prescription medications sorted by total spending, a substantial 45.3% were not listed on the MCCPDC platform. This is a trend not only for otolaryngologic medications but across a wide range of generics, as merely 26% of expensive generic drugs were available on the MCCPDC website in May 2023, underscoring the pressing need for more affordable access to expensive medications that may not be readily found in alternative drug distribution models [7]. Moreover, a large number of antibiotics were seen within our top 10 potential loss categories, suggesting that Medicare can achieve discounts for specific medication categories within drug distribution models. This is consistent with discussions on Medicare leveraging various factors, such as rebates and pharmacy-related price concessions, to save on prescription drug spending [8]. As a result, providers should carefully consider options before urging patients to order prescription workflows through DTC sources without consulting their Medicare Part D plan in order to re-emphasize our findings of a mix of savings and losses among otolaryngologic medications through theoretical MCCPDC procurement.

Limitations in the present analysis consist of Medicare Part D data not differentiating forms and doses, deeming it difficult to delineate particular medications on MCCPDC. Pricing calculations in the present cost-analysis are subject to fluctuations due to dynamic time and market conditions along with impending and future legislations pertinent to drug pricing and transparency. Only MCCPDC was selected to examine, but other DTC sources have also shown potential savings for Medicare Part D beneficiaries through hybrid approaches, which warrants additional investigation on alternative DTC sources for otolaryngologic medications and determination of the most cost-effective model [2]. Although warehouse clubs (e.g., Costco) have also shown savings on common generic drugs, these clubs are restricted to customers with active membership accounts and have limited medication scope, which hinder the generalization of results to the broader patient population [9]. Moreover, warehouse clubs deem cost-saving analysis complicated as prices are not readily available online for non-members, and hence we excluded them from our study.

Conclusion

Our study conducted a cost analysis utilizing Mark Cuban Cost Plus Drug Company (MCCPDC) for the top 75 most prescribed and expended on otolaryngologic medications. Our results indicate that sourcing select medications from MCCPDC could yield substantial cost savings but also carries risks of overspending for Medicare Part D. We suggest a tailored approach, rather than a uniform adoption of direct-to-consumer models to maximize savings while maintaining comprehensive access.