Icosapent Ethyl

To determine how utilization and spending on lipid lowering medications in Medicaid changed between 2018 and 2022.

Retrospective, cross-sectional study of utilization and spending on 32 lipid lowering drug formulations (18 brand-name, 14 generic) using the Medicaid Spending by Drug Dataset (2018-2022).

The study included over 115 million prescription fills in the Medicaid program. Between 2018 and 2022, annual prescription fills for lipid lowering medications increased 1.2%, from 22.7 million per year to 22.9 million per year, while annual Medicaid spending on these medications increased 13.2%, from $348.3 million to $394.4 million per year. Annual statin utilization remained stable over the study period (20.4 million fills in 2018 compared to 20.3 million fills in 2022), while spending on statins decreased (from $243.9 million to $228.3 million). Conversely, annual prescription fills and spending for PCSK9 inhibitors (7,617 fills and $8.9 million to 121,737 fills and $65.7 million), icosapent ethyl (32,527 fills and $10.2 million to 180,291 fills and $50.2 million), and bempedoic acid (from 494 fills and $215,499 to 4,619 fills and $2.2 million) all increased between 2018 and 2022.

Between 2018 and 2022, annual prescription fills for lipid lowering therapies in Medicaid remained stable while spending on these medications increased, driven by increased utilization of PCSK9 inhibitors, icosapent ethyl, and bempedoic acid. As Medicaid budgets face escalating financial pressure-and the burden of cardiovascular disease increases among low-income adults in Medicaid-it is critical that policymakers continue to monitor utilization and spending on existing and novel high-cost medical therapies.

Due to the unique physicochemical properties of saline-alkaline water, aquatic organisms find it challenging to survive under such conditions. This study established a freshwater control group (C), a 20 mmol/L NaHCO₃ exposure group (T), a 40 mmol/L NaHCO₃ exposure group (F), a 20 mmol/L NaHCO₃ exposure with α-ketoglutarate (AKG)-supplemented feed group (TA), and a 40 mmol/L NaHCO₃ exposure with AKG-supplemented feed group (FA). Histopathological analysis, biochemical assays, and UPLC-QTOF/MS metabolomics were employed to explore the potential mechanisms by which AKG alleviates oxidative damage in freshwater teleosts induced by saline-alkaline stress. Histopathological results showed that as the concentration of carbonate alkali exposure increased, the severity of kidney lesions in crucian carp (Carassius auratus) worsened. However, in the TA and FA groups, the damage showed varying degrees of repair, with the kidney tissue morphology in the TA group almost restored to the state of the C group. Under carbonate alkali exposure, compared to the C group, the activity of antioxidant enzymes Catalase and Superoxide dismutase in crucian carp kidneys decreased in a dose-dependent manner, but increased upon AKG supplementation. Conversely, the levels of Malondialdehyde, blood ammonia, Urea nitrogen, and Uric acid showed the opposite trend. Metabolomics analysis revealed that carbonate-alkali stress caused a series of metabolic disruptions in fish, including amino acid metabolism, lipid metabolism, and energy metabolism. AKG positively regulated metabolic pathways such as the pentose phosphate pathway, arachidonic acid metabolism, and amino acid metabolism, thereby enhancing the antioxidant, anti-inflammatory, and immune capabilities of fish under saline-alkaline stress, alleviating oxidative damage induced by the stress. Overall, our research indicates that saline-alkaline stress significantly alters kidney function and metabolic characteristics, disrupts the antioxidant system and energy homeostasis, inhibits protein catabolism, and induces kidney damage in crucian carp. Exogenous AKG supplementation effectively mitigates oxidative damage and metabolic disorders in crucian carp kidneys under carbonate-alkaline stress. This study elucidates the physiological mechanisms by which AKG alleviates kidney tissue damage under saline-alkaline stress at the metabolic level, providing scientific evidence for the development of aquaculture in saline-alkaline water.