Improving adherence to high-value medications through prescription cost-sharing policies.
Improving adherence to high-value medications through prescription cost-sharing policies.
复制标题
通过处方费用分摊政策提高对高价值药物的依从性。
DOI：
10.1136/bmjqs-2018-007916
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发表时间：
2018
影响因子：
5.4
通讯作者：
Frakt,AustinB
中科院分区：
文献类型：
--
作者：
Garrido,MelissaM;Frakt,AustinB
许多国家和卫生系统正在努力应对不断增长的医疗保健支出，特别是处方药支出。美国也不例外，人均医药支出高于任何其他经济合作与发展组织国家。1通过自付费用或共同保险进行成本分摊是尝试管理药品支出和利用的常见方法。然而，尽管费用分摊减少了潜在的不必要的药物使用，2但它也减少了对所需药物的坚持。减少依从性可能导致长期的健康损害和抵消成本。3-5分摊费用的影响可能在低收入个人中加剧。6 7以前大多数关于费用分担对依从性影响的研究都集中在至少服用过一次处方药的患者身上。相比之下，有较少的研究集中在坚持填写初始处方。在这一期中，Aznar-Lou等人的研究增加了药物依从性文献，证明初始药物不依从性（IMNA;首次开药时不填写处方）对成本分摊水平同样敏感，并且这种关系在收入水平上持续存在。该研究的结果为基于价值的保险设计（VBID）的潜在益处提供了进一步的支持，该设计旨在减少更有价值的药物的成本分摊，这些药物可以预防下游并发症，通常适用于慢性病患者。9
Many countries and health systems are struggling with growing healthcare expenditures in general, and those for prescription drugs in particular. The USA is no exception, with pharmaceutical spending per capita above that of any other Organisation for Economic Co-operation and Development country. 1 Cost-sharing through copayments or coinsurance is a common approach to attempt to manage drug spending and utilisation. However, although cost-sharing reduces potentially unnecessary medication use, 2 it also reduces adherence to needed medications. Reduced adherence can lead to long-term health detriments and to offsetting costs. 3–5 The effects of cost-sharing may be exacerbated among low-income individuals. 6 7Most previous studies of the impact of cost-sharing on adherence have focused on patients who have filled a prescription at least once. In contrast, there are fewer studies focused on adherence to filling the initial prescription. In this issue, the study by Aznar-Lou et al 8 adds to the medication adherence literature by demonstrating that initial medication non-adherence (IMNA; not filling a prescription when a medication is first prescribed) is similarly sensitive to costsharing levels, and that this relationship persists across income levels. The study’s findings provide further support for the potential benefit of value-based insurance design (VBID), which is the idea of reducing cost-sharing for more valuable medications that can prevent downstream complications, typically for patients with chronic conditions. 9