医疗补助和细胞和基因疗法的商业覆盖范围的变化
Molly T Beinfeld1, Julia A Rucker1, Nola B Jenkins1
1Tufts Medical Center, Center for the Evaluation of Value and Risk in Health, Boston, MA, United States.
Health policy OPEN
|November 29, 2023
概括
细胞和基因疗法 (CGTs) 提供创新的治疗方法,但面临覆盖范围的限制. 在美国商业和医疗补助医疗计划之间存在很大差异,影响了患者公平.
科学领域:
- 卫生经济学 卫生经济学
- 药物经济学 药物经济学
- 卫生政策 卫生政策
背景情况:
- 细胞和基因疗法 (CGTs) 在治疗严重疾病方面取得了重大进展.
- 高昂的成本和CGT的一次性管理引发了对医疗保健计划预算和患者公平获取的担忧.
研究的目的:
- 为了检查美国商业和医疗补助医疗计划11个CGT的保险政策的差异.
- 确定这些健康计划所施加的覆盖范围限制的范围和性质.
主要方法:
- 利用了来自塔夫斯医疗中心专业药物证据和覆盖 (SPEC) 数据库的覆盖数据,用于18个商业健康计划.
- 从州医疗补助网站分析了2021年8月CGT覆盖范围的信息.
主要成果:
- 商业医疗计划对53.5%的研究中CGT的保险政策施加了限制.
- 医疗补助医疗计划对68.3%的保险政策实施了限制.
- 在商业和医疗补助计划中观察到CGT访问的显著差异,一些疗法比其他疗法更受限制.
结论:
- 在商业和医疗补助医疗计划中,覆盖范围的限制和对CGT的访问的变化很普遍.
- 患者对这些创新疗法的差异性获取是当前覆盖政策的结果.
- 对CGT覆盖的临床要求往往与关键临床试验纳入标准保持一致,但并不总是相同.
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