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国家特需药设定自付上限后患者自付支出减少
作者:小柯机器人 发布时间:2020/8/8 22:14:38

美国凯撒永久华盛顿健康研究所Kai Yeung课题组研究了国家制定特需药自付上限后,患者和健康计划的支出变化。该成果发表在2020年8月6日出版的《新英格兰医学杂志》上。

特需药用于治疗复杂或危及生命的疾病,通常给患者和健康计划带来高昂的财务成本。美国特拉华州、路易斯安那州和马里兰州通过立法,以每张处方最高150美元来限制特需药的自付费用。令人担忧的是,这些上限可能会将成本转移到健康计划中,从而增加保险费用。评估该上限对患者和健康计划支出的影响可为未来政策的制定提供参考。

研究组分析了一个样本,招募了27161名65岁以下的风湿性关节炎、多发性硬化症、丙型肝炎、银屑病、银屑病性关节炎、克罗恩病或溃疡性结肠炎的患者,这些患者在2011-2016年参与了美国三大保险公司的商业健康计划。主要结局是特需药使用者自付费用的变化,他们在特需药上的花费占95%。其他结局为特需药、非特需药、以及非药物医疗和特需药使用的平均自付费用和健康计划支出的变化。

制定自付上限后,每位特需药使用者每月的自付费用平均节约了351美元,在特需药上花费占95%的患者支出减少了32%。该发现得到了多种敏感性分析的支持。自付上限与其他结局的变化无关。

总之,在最高自付费用的患者中,特需药设定自付上限可大量减少特需药相关支出,而医疗计划支出却未显著增加,这为未来保费政策提供了参考。

附:英文原文

Title: Patient and Plan Spending after State Specialty-Drug Out-of-Pocket Spending Caps

Author: Kai Yeung, Pharm.D., Ph.D.,, Douglas Barthold, Ph.D.,, Stacie B. Dusetzina, Ph.D.,, and Anirban Basu, Ph.D.

Issue&Volume: 2020-08-05

Abstract: Background

Specialty drugs are used to treat complex or life-threatening conditions, often at high financial costs to both patients and health plans. Three states — Delaware, Louisiana, and Maryland — passed legislation to cap out-of-pocket payments for specialty drugs at $150 per prescription. A concern is that these caps could shift costs to health plans, increasing insurance premiums. Estimates of the effect of the caps on patient and health-plan spending could inform future policies.

Methods

We analyzed a sample that included 27,161 persons under 65 years of age who had rheumatoid arthritis, multiple sclerosis, hepatitis C, psoriasis, psoriatic arthritis, Crohn’s disease, or ulcerative colitis and who were in commercial health plans from 2011 through 2016 that were administered by three large nationwide insurers. The primary outcome was the change in out-of-pocket spending among specialty-drug users who were in the 95th percentile for spending on specialty drugs. Other outcomes were changes in mean out-of-pocket and health-plan spending for specialty drugs, nonspecialty drugs, and nondrug health care and utilization of specialty drugs. We compared outcomes in the three states that enacted caps with neighboring control states that did not, 3 years before and up to 3 years after enactment of the spending cap.

Results

Caps were associated with an adjusted change in out-of-pocket costs of $351 (95% confidence interval, 554 to 148) per specialty-drug user per month, representing a 32% reduction in spending, among users in the 95th percentile of spending on specialty drugs. This finding was supported by multiple sensitivity analyses. Caps were not associated with changes in other outcomes.

Conclusions

Caps for spending on specialty drugs were associated with substantial reductions in spending on specialty drugs among patients with the highest out-of-pocket costs, without detectable increases in health-plan spending, a proxy for future insurance premiums.

DOI: 10.1056/NEJMsa1910366

Source: https://www.nejm.org/doi/full/10.1056/NEJMsa1910366

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home