识别医疗保险D部分表单中广泛覆盖的药物和药物覆盖范围的差异
Chien-Wen Tseng1, Carol M Mangione, Robert H Brook
1Department of Family Medicine and Community Health, John A. Burns School of Medicine at University of Hawaii, Honolulu, USA. cwtseng@hawaii.edu
JAMA
|June 21, 2007
概括
大多数医疗保险D部分药物配方为高血压,高脂血症和抑郁症提供广泛覆盖的仿制药选择. 临床医生应该验证品牌药物的覆盖范围,因为很少有广泛可用.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 药物经济学 药物经济学
- 临床药房 临床药房
背景情况:
- 医疗保险D部分计划具有高度可变的配方,使临床医生复杂化药物保险决策.
- 识别广泛覆盖的药物对于管理各种D部分计划下的患者护理至关重要.
研究的目的:
- 评估加利福尼亚和夏威夷的医疗保险D部分配方是否在关键治疗类中提供至少一种"广泛覆盖"的药物.
- 确定广泛覆盖的高血压,高脂血症和抑郁症药物的可用性.
主要方法:
- 使用medicare.gov网站 (2006年3月至4月) 分析了加利福尼亚州的72份和夏威夷州的43份医疗保险D部分表单.
- 对8种药物类别的覆盖范围的评估,包括ACE抑制剂,ARBs,β-阻断剂,通道阻断剂,循环利尿剂,SSRI,他类药物和 thiazide利尿剂.
- "广泛覆盖"被定义为包含在≥90%的配方单中,共付费≤35美元,没有事先授权.
主要成果:
- 在八个检查的药物类别中,有七个至少有一种在加利福尼亚州的配方中广泛覆盖的药物.
- 在被广泛覆盖的药物中,45%是仿制药;73%的所有仿制药被广泛覆盖,而品牌药物仅占6%.
- 在夏威夷也发现了类似的结果,这表明在两个州都有一致的模式.
结论:
- 尽管配方有很大差异,但大多数主要的治疗类包含广泛覆盖的药物,主要是仿制药.
- 临床医生需要意识到,并非所有仿制药都得到广泛覆盖,而且品牌药物覆盖范围有限.
- 验证药物覆盖对于临床医生来说至关重要,以确保患者获得并有效管理处方.
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