2026年医疗保险药物谈判产生的估计折扣
Inmaculada Hernandez1, Nico Gabriel1, Sean Dickson2
1Division of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA.
Journal of managed care & specialty pharmacy
|July 31, 2023
概括
从2026年开始,医疗保险可以谈判药品价格. 对于大多数药物,净价格将设置上限,但最低折扣将适用于10种药物中的4种,可能节省18亿美元.
科学领域:
- 卫生经济学 卫生经济学
- 制药政策 制药政策
- 药品定价 药品定价 药品定价
背景情况:
- 医疗保险即将授权从2026年开始谈判药品价格.
- 之前的报道确定了可谈判的药物,但缺乏最高价格估计.
- 基于医疗保险和医疗补助服务中心指导的分析需求.
研究的目的:
- 确定2026年10种关键医疗保险药物的最大谈判药品价格.
- 估计这些谈判所带来的潜在节约.
主要方法:
- 利用同行评审的方法来估计2020年的药品折扣.
- 将估计的折扣与法定最低折扣进行了比较.
- 计算的最大谈判价格和预计的节省.
主要成果:
- 最低折扣超过2020年10种药物中的4种药物的折扣 (etanercept,ibrutinib,palbociclib,enzalutamide).
- 这四种药物面临的最低折扣为60%或25%,而较低的折扣估计较低.
- 根据这些4种药物的2020年总支出,预计可节省18亿美元.
结论:
- 在2026年,最低折扣只会影响10种可能谈判的药物中的4种.
- 净价格很可能会决定大多数药物的谈判价格上限.
- 实现预计的节约需要在法定上限以下的谈判价格.
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