• Jeromie Ballreich, Mariana Socal, Charles L Bennett, Martin W Schoen, Antonio Trujillo, Andrew Xuan, and Gerard Anderson.
• Department of Health Policy & Management and Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (J.B., M.S., G.A.).
• Ann. Intern. Med. 2022 Jul 1; 175 (7): 938-944.

BackgroundThe U.S. Food and Drug Administration provides accelerated approval to drugs on the basis of surrogate end points deemed to be "reasonably likely" to predict clinical benefit. To receive full approval, drugs must complete a confirmatory trial. Although most accelerated approved drugs ultimately receive full approval, others remain on the market without full approval for many years, and some are withdrawn before full approval is granted. Until confirmatory trials are completed and full approval is granted, there is uncertainty surrounding each drug's clinical benefits.ObjectiveTo estimate fee-for-service Medicare payments on accelerated approved drugs without full approvals.DesignCross-sectional analysis.SettingFee-for-service Medicare Part B and Part D drug claims in 2019.ParticipantsBeneficiaries enrolled in Medicare Part B and Part D plans.MeasurementsMedicare spending for drugs treating accelerated approved indications without full approval, beneficiary spending, and drug characteristics.ResultsIn 2019, 45 drugs associated with 69 accelerated approved indications lacked full approval. Of those, the fee-for-service Medicare program spent $1.2 billion on 36 drugs across 55 indications. Medicare beneficiaries had $209 million in out-of-pocket spending on these drugs. Oncology drugs represented 82% of these indications and 72% of the Medicare spending. Extrapolating to Medicare Advantage, total Medicare spending on these drugs in 2019 was $1.8 billion.LimitationsThe study drugs may have clinical benefit and may come to receive full approval after this analysis. The algorithm used to identify accelerated approved indications is novel. Generalizability to other years is unclear.ConclusionIn 2019, fee-for-service Medicare spent $1.2 billion on accelerated approved drugs without full approval. Medicare should adjust incentives to encourage sponsors to complete confirmatory trials as soon as possible.Primary Funding SourceLaura and John Arnold Foundation.

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