在接受透析的费用服务医疗保险受益人中使用仿药的处方
Jillian S Caldwell1, Xingxing S Cheng1, Eran Bendavid2
1Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
JAMA health forum
|April 18, 2025
概括
医疗保险的TDAPA政策在末期病患者中增加了仿药的使用. 这一变化特别有利于那些面临高额自费费用的人,改善了药物获取.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 卫生政策 卫生政策
- 药物经济学 药物经济学
背景情况:
- 二次性偏甲状腺症 (sHPT) 在末期病 (ESKD) 中很常见,增加骨折,心血管事件和死亡的风险.
- 模仿药对于sHPT管理至关重要,但成本障碍影响了患者的获取.
- 医疗保险的过渡期药物附加支付调整 (TDAPA) 在2018年将模性药物覆盖范围从D部分转移到B部分.
研究的目的:
- 评估TDAPA政策对仿药处方率的影响.
- 评估在TDAPA前自付成本较高的患者是否经历了较大的石模拟剂使用增加.
主要方法:
- 一项纵向队列研究分析了从2016年7月到2020年12月接受维持透析的成年医疗保险收费服务受益者.
- 一个差异分析分析检查了TDAPA实施前和之后的处方率.
- 模型根据患者人口统计学,透析特征,并发病症和设施因素进行调整.
主要成果:
- 这项研究包括509,765名患者.
- 实施TDAPA与D部分覆盖但没有低收入补贴 (LIS) 的患者的素仿制药处方增加9.8个百分点有关.
- 与完全补贴患者相比,部分LIS患者的病率增加了2.2个百分点.
结论:
- 由于TDAPA政策导致了仿药处方的逐步增加.
- 以前面临最高自费费用的患者受益最多,这表明改善了药物获取.
- 医疗保险的TDAPA政策显示了提高患者获得基本药物的潜力.
相关概念视频
01:11Renal Failure: Dose Adjustments
35
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
35
01:27Dialysis
228
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
228
01:22Heart Failure Drugs: Diuretics
282
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
282
01:28Antihypertensive Drugs: Potassium-Sparing Diuretics
401
Liddle syndrome is a genetically inherited form of hypertension characterized by the overactivity of epithelial sodium channels in the nephron, the functional unit of the kidney. This heightened activity leads to increased sodium reabsorption and excessive excretion of potassium. To counteract this, potassium-sparing diuretics such as amiloride are used. They function by blocking these sodium channels, thereby reducing the influx of sodium into the epithelial cells and minimizing the loss of...
401
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
305
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
305
01:21Skeleton and Calcium Homeostasis
4.2K
Calcium is not only the most abundant mineral in bone but also the most abundant mineral in the human body. Calcium ions are needed for bone mineralization, tooth health, heart rate regulation and strength of contraction, blood coagulation, the contraction of smooth and skeletal muscle cells, and the regulation of nerve impulse conduction. The average calcium level in the blood is about 10 mg/dL. When the body cannot maintain this level, a person will experience hypo or hypercalcemia.
4.2K