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在通货膨胀减缓法案颁布后,医疗保险D部分计划设计的变化
Christopher L Cai1, Anushka Bhaskar1, Aaron S Kesselheim1
1Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
JAMA internal medicine
|August 18, 2025
概括
"通货膨胀减缓法案" (IRA) 导致医疗保险D部分受益人,特别是医疗保险优势计划的受益人,尽管联邦保费上限,但其口袋处方药费用增加. 可能需要进一步的政策干预,以确保药物负担能力.
科学领域:
- 卫生政策 卫生政策
- 制药经济学 制药经济学
- 医疗保险D部分
背景情况:
- "通货膨胀减少法" (IRA) 颁布了从2024年和2025年开始对医疗保险D部分处方药的覆盖范围的重大变化.
- 这些变化包括2000美元的年度自费支出限制,以及从政府转移到计划赞助商的财务责任.
- 旨在防止2025年保费增加的联邦政策,可能导致D部分计划调整自扣额和成本共享要求.
研究的目的:
- 量化医疗保险D部分保费,自扣额和药物成本共享的年度变化.
- 从2019年到2025年,分析独立计划和医疗保险优势计划中的这些变化.
- 评估IRA对受益人的自付费用的影响.
主要方法:
- 采用了一系列的横截面研究设计,利用2019年至2025年的Medicare Part D入学者的数据.
- 主要结果包括平均月度保费,年度自扣额,以及各种药物级别的共同保险与共同支付的普遍性.
- 估计了九种高成本,非特种,品牌药物的平均月度自付费用,并根据计划入学量进行加权.
主要成果:
- 医疗保险优势计划的自扣额从2019年到2024年有所下降,然后在2025年上升到228美元. 首选品牌药物的共同保险在2025年显著增加 (27.7%).
- 医疗保险优势计划中的九种关键药物的自用费用在2025年上升到每月73美元.
- 到2025年,独立的D部分计划的自扣额稳步增加到490美元,并将首选品牌药物的共同保险增加到84.0%,月度药物成本达到108.0美元.
结论:
- 在2024-2025年实施IRA的D部分变化与计划设计修改相吻合,这些修改似乎增加了受益人成本共享.
- 这些增长对于个人而言尤其显著,这些个人不超过2000美元的自取限制,以及那些参加医疗保险优势计划的人.
- 可能需要采取额外的政策措施来减轻成本共享的增加,并确保基本的医疗保险D部分药物的负担能力.
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