Cost Comparison of Fixed Dose Combination vs. Monotherapy Antihypertensive Therapies: A Medicare Part D Analysis (2013 to 2022)

Fixed-dose combination (FDC) antihypertensive therapies are widely used to improve adherence and simplify hypertension management, but their long-term cost patterns compared with prescribing individual component drugs remain unclear. We analyzed national Medicare Part D Prescription Drug Event data from 2013 to 2022 to compare the average cost per claim and per beneficiary for six two-drug FDC antihypertensive therapies and the summed costs of their individual components. Analyses were limited to years with complete data for both the combination and its components, and ten-year averages were calculated. Three of the six FDC therapies were less expensive than prescribing their components separately. The greatest savings were seen with valsartan/hydrochlorothiazide ($1 per claim, $174 per beneficiary), lisinopril/hydrochlorothiazide ($4 per claim, $20 per beneficiary), and atenolol/chlorthalidone ($12 per claim, $44 per beneficiary). Amlodipine/valsartan ($63 per claim, $115 per beneficiary), telmisartan/amlodipine ($105 per claim, $386 per beneficiary), and irbesartan/hydrochlorothiazide ($3 per claim, $12 per beneficiary) were more expensive. This national Medicare analysis found that several fixed-dose combination antihypertensive therapies cost less than prescribing their individual components, while others remain more expensive. These results highlight clear differences in drug pricing that may help guide value-based prescribing and formulary decisions in hypertension management.