专用药物覆盖范围在健康计划的医疗和药房福利政策之间有所不同
A Alex Levine1, Ari D Panzer1, Teresa L Kauf2
1The Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
Journal of managed care & specialty pharmacy
|June 5, 2023
概括
医疗保健计划通常有医疗和药房政策,用于特殊药物. 虽然大部分都是一致的,但14%的这些政策显示出差异,可能会影响患者获得药物的机会.
科学领域:
- 卫生经济学 卫生经济学
- 制药政策 制药政策
- 临床药房 临床药房
背景情况:
- 医疗保健计划越来越多地将专用药物转移到药房,以控制成本.
- 这导致同一药物的双重医疗和药房保险政策.
- 这些政策之间可能会出现不一致.
研究的目的:
- 确定特种药物的双重医疗和药房政策的频率.
- 评估这些政策之间的一致性.
- 为了确定覆盖标准不一致的原因.
主要方法:
- 来自美国17个大型商业健康计划的专业药物保险政策分析 (2020年8月).
- 识别同一种药物和适应症的"医疗药品政策对".
- 覆盖标准的比较,包括患者子组,处方要求和步骤治疗.
主要成果:
- 八个健康计划发布了单独的医疗和药房政策.
- 确定了1,619个医疗药房政策对.
- 86%的对是一致的;14%是不一致的.
- 不一致性最常见的是涉及步骤治疗 (184/233) 和处方要求 (52/233).
- 在54%的不一致案例中,药房政策更为严格.
结论:
- 专用药品的商业健康计划政策显示,医疗和药房福利之间存在普遍的一致性.
- 然而,覆盖标准存在14%的不一致.
- 不一致的政策使患者获得必要的专用药物变得复杂.
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