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Los planes de beneficios de drogas del empleador y el gasto en medicamentos recetados
Geoffrey F Joyce1, José J Escarce, Matthew D Solomon
1RAND Health, 1700 Main St, Santa Monica, CA 90407-2138, USA. gjoyce@rand.org
JAMA
|October 9, 2002
Resumen
Los cambios en los beneficios del seguro de salud, como mayores copagos y la sustitución obligatoria de genéricos, redujeron significativamente el gasto en medicamentos para los empleadores. Sin embargo, estos cambios aumentaron los costos de bolsillo para los beneficiarios, desplazando la carga financiera.
Área de la Ciencia:
- Economía de la salud economía de la salud.
- La política farmacéutica en el ámbito de la salud
- Gestión de la gestión de beneficios de seguros.
Sus antecedentes:
- El aumento del gasto en medicamentos recetados afecta a los adultos en edad de trabajar.
- Los empleadores y las aseguradoras están implementando cambios en los beneficios para controlar los costos de los medicamentos.
- El efecto de estas iniciativas en el gasto total en drogas sigue sin estar claro.
Objetivo del estudio:
- Evaluar el impacto de las innovaciones de beneficios de seguro de salud en los costos de los medicamentos.
- Analizar cómo las fórmulas multinivel y la sustitución obligatoria de genéricos afectan el gasto total en medicamentos para las aseguradoras y los pagos de bolsillo para los beneficiarios.
Principales métodos:
- Estudio retrospectivo que analiza los datos de las reclamaciones de 1997-1999.
- Se incluyeron 420.786 beneficiarios de entre 18 y 64 años de 25 grandes empresas con cobertura de medicamentos para pacientes ambulatorios.
- Examinó los costos generales de los medicamentos, los gastos de medicamentos genéricos y de marca, los pagos de las aseguradoras y los costos de bolsillo del beneficiario.
Principales resultados:
- El aumento de los copagos redujo los costos anuales promedio de drogas por miembro en un 22,3% (1er nivel) y 32,9% (2er nivel).
- La sustitución obligatoria de genéricos en un plan de dos niveles redujo el gasto en medicamentos en un 8%.
- El aumento de los copagos en los planes de dos niveles aumentó el gasto de bolsillo de los beneficiarios del 17,6% al 25,6%.
Conclusiones:
- Los cambios en el diseño de los beneficios, incluido el aumento de los copagos y la sustitución obligatoria de genéricos, redujeron efectivamente el gasto general en medicamentos para los empleadores.
- Estas reducciones de costos beneficiaron principalmente a los planes de seguros.
- Los beneficiarios experimentaron un aumento significativo en sus gastos de drogas de bolsillo.
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