Financial burden of once daily extended-release tacrolimus and twice daily immediate-release tacrolimus for kidney transplant recipients

Tacrolimus is available as generic twice-daily, immediate-release capsules (IR-Tac) or branded once-daily, extended-release tablets (LCPT). Prescribers may be hesitant to prescribe LCPT due to the price of the branded drug. This single-center, retrospective study evaluated if adult kidney transplant patients paid significantly more for IR-Tac or LCPT prescriptions where institutional assistance is available. Adult kidney transplant recipients filling prescriptions for IR-Tac or LCPT from January 1, 2021 through June 30, 2022 were included. Descriptive statistics were used to summarize the amount of out-of-pocket costs covered by secondary insurance and by institutional assistance. Of 18,411 fills (<i>n</i> = 16,262 IR-Tac, <i>n</i> = 2149 LCPT), the average out-of-pocket cost was $2.90 more for IR-Tac (mean $8.10, standard deviation [SD] 26.2) than LCPT (mean $5.20, SD 33.0). Secondary insurance covered an average $42.10 per fill for IR-Tac and $152.96 for LCPT. Institutional assistance covered an average $32.74 per fill for IR-Tac and $198.53 for LCPT in patients without secondary insurance. Patients prescribed LCPT were significantly less likely to have higher out-of-pocket cost (odds ratio [OR] 0.16 [0.09, 0.3], <i>p</i> < 0.001). No additional financial burden was placed on patients taking LCPT. However, patients with high copay or deductible primary insurance are at risk for high out-of-pocket costs for both IR-Tac and LCPT.