为什么较高的阿片类药物共同支付并没有减少医疗保险受益者使用阿片类药物?
Geoffrey Joyce1, Bo Zhou1,2, Robert Kaestner1,3
1University of Southern California School of Pharmacy, Schaeffer Center for Health Policy and Economics and NBER, Los Angeles, California, USA.
Health economics
|November 20, 2023
概括
更高的处方药成本并没有显著减少阿片类药物使用. 增加的共同支付导致了更多的自费支出,因为仿制药的可用性和政策规定限制了成本共享对整体阿片类药物消费的影响.
科学领域:
- 卫生经济学 卫生经济学
- 制药政策 制药政策
- 吸食阿片类药物使用研究研究
背景情况:
- 医疗保险D部分计划实施了福利变化,以制处方阿片类药物使用.
- 这些变化包括将阿片类药物转移到更高的成本共享级别.
研究的目的:
- 评估增加成本共享对医疗保险受益人处方阿片类药物使用的影响.
- 了解仿制药的可用性和政策规定如何影响成本共享在减少阿片类药物使用方面的有效性.
主要方法:
- 对2007-2016年20%的随机样本的Medicare Part D索赔数据的分析.
- 使用普通最小平方和工具变量方法来估计成本共享的影响.
- 员工随着时间的推移在计划中的成本分担变化,受益人留在同一个计划中以减轻偏差.
主要成果:
- 对特定阿片类药物 (可,氧可) 的共同支付增加与计划支付索赔减少相关.
- 观察到与此同时,口袋外现金索赔的增加,这表明支付方式的转变,而不是减少使用.
- 低成本仿制阿片类药物的广泛可用性和D部分反追回条款在很大程度上中和了更高成本共享的预期效果.
结论:
- 更高的成本共享本身不足以阻止处方阿片类药物使用,这是由于通用药物的可用性和政策保护.
- 医疗保险D部分的反回扣条款限制了计划通过增加成本共享来控制阿片类药物使用的能力.
- 旨在减少阿片类药物使用的政策干预需要考虑成本共享,仿制药市场和监管条款的相互作用.
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