在医疗保险优势计划中,步骤治疗的使用多样化
Nola B Jenkins, Donald E Nichols, Daniel E Enright
1Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St, Boston, MA 02111-1845.
The American journal of managed care
|September 20, 2023
概括
医疗保险优势计划经常使用步骤治疗,在应用和与FDA指示一致性方面存在显著差异. 保险公司在医疗保险优势和商业药物保险之间的步骤治疗协议上也存在差异.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 制药政策 制药政策
- 卫生经济学 卫生经济学
背景情况:
- 步骤治疗是一种成本控制措施,需要患者在更昂贵的药物之前尝试更便宜的药物.
- 医疗保险优势 (MA) 计划越来越普遍,影响受益人获得药物的机会.
- 了解MA中步骤治疗的利用对于患者获取和医疗保健成本至关重要.
研究的目的:
- 为了检查七个大型医疗保险优势计划使用步骤治疗的频率.
- 为了比较MA药物保险中的步骤治疗协议与相同健康计划中的商业 (雇主) 药物保险政策.
主要方法:
- 使用塔夫斯医疗中心专业药物证据和覆盖数据库,分析了七个大型MA计划的药物覆盖政策.
- 步骤治疗频率的评估,ICD-10类别的应用,与FDA标签指示的一致性以及MA和商业计划之间的比较.
主要成果:
- 在MA计划中,步骤治疗的频率从26.1%到63.7%不等,在皮肤学中最常见 (90.2%),在瘤学中最少 (28.6%).
- 平均而言,MA阶段疗法与FDA的适应性仅在29.0%的时间内一致.
- 步骤治疗方案在MA和商业计划之间对于相同的药物指示对有46.1%的差异.
结论:
- 在MA计划如何为B部分药物实施步骤治疗方面存在显著差异.
- 保险公司经常在他们的MA和商业产品中应用不同的步骤治疗协议.
- 步骤治疗要求的差异可能导致患者在Medicare Advantage中获得不平等的药物.
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