Ten-year Cost Trends of Rate and Rhythm Control Medications in the United States, 2013-2022

BackgroundRate and rhythm control medications remain central to atrial fibrillation (AF) management, even as catheter ablation becomes increasingly preferred for select patients. However, national spending patterns and cost disparities between these medication classes under Medicare Part D remain poorly defined. ObjectivesTo evaluate Medicare Part D spending trends and cost differences between rate and rhythm control agents from 2013 to 2022. MethodsA retrospective analysis of Medicare Part D Prescription Drug Event data (2013-2022) was performed, including 13 commonly prescribed monotherapy agents categorized as rate or rhythm control. For each drug, total annual spending, cost per claim, and cost per beneficiary were calculated. Linear regression assessed temporal cost trends, and independent t-tests compared rate versus rhythm classes. Statistical significance was defined as p < 0.05. ResultsRate control agents showed a significant decline in cost per claim (p = 0.003), driven by metoprolol succinate (-53.9%, p < 0.001). Rhythm control agents demonstrated significant increases in both cost per claim (p < 0.001) and cost per beneficiary (p = 0.026). Dronedarone rose from $2,166 to $5,374 per beneficiary (p < 0.001), while flecainide increased to $71 per claim and $276 per beneficiary (p = 0.001, p = 0.036). Despite generic availability, amiodarone, verapamil, and diltiazem also trended upward. Across all years, rhythm agents remained more expensive than rate agents (p < 0.001). ConclusionFrom 2013-2022, Medicare costs decreased for rate control medications but rose sharply for rhythm agents. Addressing these disparities through transparent pricing and formulary reform is essential to preserve equitable access to rhythm control therapy.