降低通货膨胀法案最大公平价格是否会伤害患者?
Anne M Sydor1, Esteban Rivera1, Robert Popovian1,2
1Global Healthy Living Foundation, Upper Nyack, New York, USA.
Journal of health economics and outcomes research
|December 4, 2024
概括
药房福利管理人员 (PBMs) 可能会增加医疗保险商定药物的患者自付费用,导致更高的治疗放弃率和抗凝剂的不良健康结果,如apixaban和rivaroxaban.
科学领域:
- 卫生经济学和政策
- 制药管理 制药管理
- 患者研究成果研究结果
背景情况:
- 美国通货膨胀减缓法案的医疗保险药品价格谈判计划使政府能够谈判药品价格.
- 药房福利管理者 (PBMs) 可能面临这些价格上限的收入压力.
- PBM可能会通过增加限制药物的自付费用来将成本转移到患者身上.
研究的目的:
- 为模拟增加阿皮克萨班和里瓦罗克萨班的自费成本的财务和临床影响.
- 评估潜在的患者放弃治疗以及随后的发病率和死亡率.
- 评估医疗保险药品价格谈判计划对患者成本的下游影响.
主要方法:
- 使用了2023年阿皮克萨班和里瓦罗克萨班主要PBMs的处方填充数据.
- 通过将处方转移到最高的共同付款级别来模拟增加的自付费用.
- 基于共同付款增加和估计的发病率/死亡率计算治疗放弃率.
主要成果:
- 转向最高的共同支付水平可能会使患者的费用增加4.82亿美元的阿皮克萨班和2.06亿美元的Rivaroxaban.
- 这可能导致169,000-228,000名患者放弃阿皮克萨班和71,000-93,000患者放弃里瓦罗克萨班.
- 估计的增加包括多达145,000个主要的心血管事件和97,000个额外的死亡.
结论:
- 医疗保险价格谈判计划可能会对患者产生负面影响,如果PBM增加了自费药物成本.
- 决策者必须监控药品的整体负担能力和患者的支出.
- 需要采取积极的措施,保护弱势群体免受不良健康后果的影响.
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