权衡证据和需求:美国商业付款人对素的覆盖范围的变化
Ekwu B Ochigbo1, Molly T Beinfeld1, James D Chambers1
1Center for the Evaluation of Value and Risk (CEVR), Boston, Massachusetts.
Clinical therapeutics
|July 22, 2024
概括
美国商业医疗保险计划显示,对乙胺 (Spravato) 的保险有显著的差异,这影响了对主要抑郁症 (MDD) 和耐治疗抑郁症 (TRD) 的治疗. 这些差异可能会推迟紧急的患者治疗.
科学领域:
- 药物经济学和医疗服务研究研究 药物经济学和医疗服务研究
- 精神病学和心理健康 精神病学和心理健康
背景情况:
- 商业健康计划的覆盖政策显著影响患者获得药物的机会.
- 政策在治疗准入标准,治疗线和处方要求方面有所不同.
研究的目的:
- 检查美国商业健康计划对大抑郁症 (MDD) 和治疗耐药性抑郁症 (TRD) 的乙胺 (Spravato) 的覆盖范围.
- 确定这些计划如何指导患者及时获得esketamine.
主要方法:
- 分析了2022年12月活跃的18个美国大型商业健康计划的保险政策.
- 基于步骤治疗,患者子组限制和处方者标准的政策的比较.
主要成果:
- 医疗计划更频繁地对TRD (1-5步) 施加步骤治疗,而不是MDD (≤9步).
- 在所需的先前疗法和临床评估门上存在显著的差异,以获得胺胺.
- 在用于评估抑郁症症状严重程度的评级尺度上,覆盖要求有所不同.
结论:
- 美国商业医疗计划在治疗线和埃斯基坦胺获取临床要求方面表现出相当大的差异.
- 覆盖政策的差异可能导致患者和临床医生的不公平获取和增加复杂性.
- 这些变异可能会阻碍及时获得MDD和TRD的基本治疗方法.
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