Forecasting Medicaid Expenditures for Antipsychotic Medications
Forecasting Medicaid Expenditures for Antipsychotic Medications
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DOI：
10.1176/appi.ps.201400042
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发表时间：
2015-07-01
影响因子：
3.8
通讯作者：
Simoni-Wastila, Linda
中科院分区：
文献类型：
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作者：
Slade, Eric P.;Simoni-Wastila, Linda
目的：正在进行的从使用大部分品牌药物到大部分通用的第二代抗精神病药物的过渡可能会大幅减少医疗补助中用于抗精神病药物的支出，这一变化对医疗补助中第二代抗精神病药物的处方集限制具有重要意义。本研究预测了仿制药对医疗补助抗精神病药物支出的影响。方法：2008年至2011年间医疗补助门诊抗精神病药物处方的季度（N=816）州级汇总数据来自医疗补助州药物利用数据库。每种抗精神病药物的处方数、支出和每张处方的成本均为年度数据。2016年和2019年的抗精神病药物支出预测是根据利培酮医疗补助支出的估计百分比减少而制定的，利培酮是整个研究期间唯一的第二代抗精神病药物。两个模型的节省从通用利培酮的使用进行了估计，一个是基于恒定的利培酮价格，另一个是基于可变的利培酮价格。支出预测的敏感性，以预期的变化，医疗补助enrollment.Results：在主模型中，抗精神病药物的年度医疗补助支出预计将减少17.94亿美元（48.8%），到2016年和28.14亿美元（76.5%），到2019年。调整可变价格的品牌药物和医疗补助登记的变化，只有适度影响这些reductions.Conclusions的幅度：在五年内，抗精神病药物的支出在医疗补助可能会下降到不到一半，目前的水平。这样的开支减少需要重新评估医疗补助计划中第二代抗精神病药物处方集限制的持续必要性。
Objective: The ongoing transition from use of mostly branded to mostly generic second-generation antipsychotic medications could bring about a substantial reduction in Medicaid expenditures for antipsychotic medications, a change with critical implications for formulary restrictions on second-generation antipsychotics in Medicaid. This study provided a forecast of the impact of generics on Medicaid expenditures for antipsychotic medications.Methods: Quarterly (N=816) state-level aggregate data on outpatient antipsychotic prescriptions in Medicaid between 2008 and 2011 were drawn from the Medicaid state drug utilization database. Annual numbers of prescriptions, expenditures, and cost per prescription were constructed for each antipsychotic medication. Forecasts of antipsychotic expenditures in calendar years 2016 and 2019 were developed on the basis of the estimated percentage reduction in Medicaid expenditures for risperidone, the only second-generation antipsychotic available generically throughout the study period. Two models of savings from generic risperidone use were estimated, one based on constant risperidone prices and the other based on variable risperidone prices. The sensitivity of the expenditure forecast to expected changes in Medicaid enrollment was also examined.Results: In the main model, annual Medicaid expenditures for antipsychotics were forecasted to decrease by $1,794 million (48.8%) by 2016 and by $2,814 million (76.5%) by 2019. Adjustment for variable prices of branded medications and changes in Medicaid enrollment only moderately affected the magnitude of these reductions.Conclusions: Within five years, antipsychotic expenditures in Medicaid may decline to less than half their current levels. Such a spending reduction warrants a reassessment of the continued necessity of formulary restrictions for second-generation antipsychotics in Medicaid.