福利设计和生物类似保险在医疗保险中的覆盖范围D部分:最近改革的证据和影响
1Luca Bertuzzi, Charles River Associates, Boston, Massachusetts.
Health affairs (Project Hope)
|May 6, 2024
概括
医疗保险D部分计划通常偏爱昂贵的生物药物而不是生物仿制药,与雇主计划不同. 诸如"两党预算法案"之类的改革改善了生物相似产品的覆盖范围,未来的立法可能会进一步增加,从而可能节省成本.
科学领域:
- 卫生经济学 卫生经济学
- 制药政策 制药政策
- 使用药物使用药物使用.
背景情况:
- 在医疗保险D部分和雇主赞助的健康保险之间,生物类似药和生物药的覆盖面存在显著差异.
- 部分D计划设计可能会激励使用更昂贵的生物药物,而不是成本效益较高的生物仿制药.
研究的目的:
- 分析随着时间的推移影响药物覆盖范围的福利设计激励措施.
- 为了比较医疗保险D部分与雇主计划中的生物类似药和参考生物药的配方覆盖范围.
- 评估2018年两党预算法案对医疗保险D部分表单覆盖率的影响.
主要方法:
- 对福利设计动态和表单覆盖率趋势的分析.
- 医疗保险D部分和雇主赞助的健康保险表单的比较研究.
- 两党预算法案对生物相似覆盖范围的影响评估在D部分.
主要成果:
- 医疗保险D部分计划中的生物相似覆盖率在两党预算法案实施后的五个季度增加了23个百分点.
- 两党预算法案的改革积极影响了生物相似覆盖率.
结论:
- 预计2022年通货膨胀减缓法案将进一步加强生物类似药的覆盖范围.
- 将医疗保险D部分配方与雇主赞助的计划结合起来,可以为患者和联邦政府节省大量成本.
- 药物覆盖与使用密切相关,这突显了药单设计的重要性.
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