691 Visualization of Covid-19 pandemic influence on healthcare routines in dermatology using electronic health record data
691 Visualization of Covid-19 pandemic influence on healthcare routines in dermatology using electronic health record data
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DOI：
10.1016/j.jid.2023.03.699
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发表时间：
2023-04-17
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局部类固醇是世界范围内皮肤科实践中最常用的处方药之一。不断上涨的处方药成本导致患者和支付方的经济负担日益加重。近年来，联邦政府资助的处方药保险项目联邦医疗保险D部分（Medicare Part D）实施了新的政策改革，以应对快速增长的支出。我们试图确定这些政策对局部类固醇成本的影响。本研究旨在分析医疗保险D部分局部类固醇支出的趋势，并模拟如果为每个索赔开出相同效力类别中最便宜的药物，可能节省的费用。数据来自医疗保险D部分处方者公共使用文件（2011-2020）。所有费用均以2020年美元计算，并根据通货膨胀进行了调整。从2011年到2020年，联邦医疗保险D部分用于局部类固醇的总支出为55亿美元。自2011年以来，总支出和处方数量分别增长了81.9%和63.2%。从2011年（2.6亿美元）到2015年（8.47亿美元），年度总支出显著增加226.5%，从2015年到2020年（4.72亿美元）下降44.3%。仿制药占大部分（98.5%），2011-2015年（97.8%）和2016-2020年（99.1%）之间绝对增长了1.3%。我们估计，如果在2016年至2020年期间，所有局部类固醇都被其效力类别中最便宜的选择所取代，可能节省17亿美元。每个类别中最便宜的局部类固醇的索赔比例稳步上升，从67.7%（2016年）上升到76.5%（2020年）。美国在局部类固醇上的支出很高，但在过去五年中有所减少。除了处方者可以更好地选择更便宜的药物外，这些费用还可以通过增加非专利选择和政策变化来调整。进一步的结构性努力是必要的，以提高药品支出的透明度，最大限度地降低成本，并增加患者负担得起的处方的比例。
Topical steroids are one of the most prescribed drugs by dermatology practices worldwide. Rising prescription drug costs leads to growing financial burden for patients and payers. In recent years, Medicare Part D, the federally funded insurance program for prescription drug coverage in the United States, has enforced new policies changes to combat rapidly rising spending. We seek to identify the impact of these policies on topical steroid costs. This study aims to analyze trends in Medicare Part D spending on topical steroids and to model potential savings if the cheapest drug within the same potency class was prescribed for each claim. Data was acquired from the Medicare Part D Prescriber Public Use Files (2011-2020). All costs are reported in 2020 US dollars and adjusted for inflation. Overall Medicare Part D spending on topical steroids from 2011 to 2020 was $5.5 billion. Since 2011, total spending and number of prescriptions increased by 81.9% and 63.2%, respectively. Total annual spending markedly increased by 226.5% from 2011 ($260 million) to 2015 ($847 million) and decreased by 44.3% between 2015 and 2020 ($472 million). Generic drugs accounted for most claims (98.5%), with an absolute increase of 1.3% between 2011-2015 (97.8%) and 2016-2020 (99.1%). We estimated potential savings of $1.7 billion if all topical steroids were substituted for the cheapest option in their potency classes between 2016 and 2020. The percent of claims for the cheapest topical steroid within each class is steadily rising, from 67.7%(2016) to 76.5%(2020). United States spending on topical steroids is high but has reduced over the past five years. In addition to improved selection of cheaper agents by prescribers, these costs are modified by increased availability of generic options and policy changes. Further structural efforts are necessary to improve transparency of drug spending, minimize costs, and increase the proportion of affordable prescriptions for patients.