雇主药物福利计划和处方药的支出
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
概括
医疗保险福利变化,如更高的共同支付和强制性仿制药替代,大大减少了雇主对药物的支出. 然而,这些变化增加了受益人的自费成本,转移了财务负担.
科学领域:
- 卫生经济学 卫生经济学
- 制药政策 制药政策
- 保险福利管理 管理保险福利
背景情况:
- 随着处方药消费的增加,就业年龄的成年人也受到影响.
- 雇主和保险公司正在实施福利改变,以控制药物成本.
- 这些举措对药物总体支出的影响仍然不清楚.
研究的目的:
- 评估医疗保险福利创新对药品成本的影响.
- 分析多层配方药和强制性仿制药替代品如何影响保险公司的药品总支出和受益人的自付支付.
主要方法:
- 追溯研究分析了1997-1999年的索赔数据.
- 包括来自25家大型企业的420,786名年龄在18-64岁之间的受益者,这些受益者有门诊药物覆盖.
- 检查了药品总成本,仿制药和品牌药品支出,保险公司支付和受益人的自付费用.
主要成果:
- 增加共同支付将每名会员的平均年度药物成本降低了22.3% (1级) 和32.9% (2级).
- 在二级计划中,强制性仿制药替代降低了8%的药物支出.
- 在二级计划中支付额度更高,受益人的自付支出从17.6%增加到25.6%.
结论:
- 福利设计的变化,包括增加共同支付和强制性仿制药替代,有效地减少了雇主对药物的总体支出.
- 这些成本削减主要受益于保险计划.
- 受益人经历了药品开支大幅增加.
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