Many Medicare Beneficiaries Do Not Fill High-Price Specialty Drug Prescriptions
Many Medicare Beneficiaries Do Not Fill High-Price Specialty Drug Prescriptions
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DOI：
10.1377/hlthaff.2021.01742
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发表时间：
2022-04-01
期刊：
影响因子：
9.7
通讯作者：
Keating, Nancy L.
中科院分区：
文献类型：
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作者：
Dusetzina, Stacie B.;Huskamp, Haiden A.;Keating, Nancy L.
对于高价药物，没有获得低收入补贴的联邦医疗保险D部分受益人必须为每次药物填充支付一定比例的药价。没有这种补贴，受益人通常会为一次填充支付数百或数千美元，这会降低自掏腰包的支出。我们估计了在有补贴和没有补贴的养老服务联邦医疗保险中，不开始治疗(即不填写新处方)的D部分受益人的比例，这些药物新开了四种情况的高价格D部分药物。我们检查了2012至2018年间为来自11个地理位置不同的医疗系统的D部分受益人发布的17,076张新处方，发现接受补贴的受益人在90天内获得处方药的可能性几乎是没有补贴的受益人的两倍。在没有补贴的受益人中，我们观察到30%的抗癌药物处方不启动，22%用于丙型肝炎治疗，超过50%用于治疗免疫系统紊乱或高胆固醇血症的疾病修改疗法。我们的发现支持了目前的立法努力，即通过减少联邦医疗保险D部分下的自付费用，特别是对没有低收入补贴的受益人，来增加高价药物的可及性。
For high-price drugs, Medicare Part D beneficiaries who do not receive a low-income subsidy must pay a percentage of the drug's price for each medication fill. Without that subsidy, which lowers out-of-pocket spending, beneficiaries typically pay hundreds or thousands of dollars for a single fill. We estimated the proportion of Part D beneficiaries in feefor-service Medicare, with and without a subsidy, who do not initiate treatment (that is, do not fill a new prescription) with high-price Part D drugs newly prescribed for four conditions. Examining 17,076 new prescriptions issued between 2012 and 2018 for Part D beneficiaries from eleven geographically diverse health systems, we found that beneficiaries receiving subsidies were nearly twice as likely to obtain the prescribed drug within ninety days as those without subsidies. Among beneficiaries without subsidies, we observed noninitiation for 30 percent of prescriptions written for anticancer drugs, 22 percent for hepatitis C treatments, and more than 50 percent for disease-modifying therapies for either immune system disorders or hypercholesterolemia. Our findings support current legislative efforts to increase the accessibility of highprice medications by reducing out-of-pocket expenses under Medicare Part D, particularly for beneficiaries without low-income subsidies.