Improving Access to High-Value, High-Cost Medicines: The Use of Subscription Models to Treat Hepatitis C Using Direct-Acting Antivirals in the United States
Improving Access to High-Value, High-Cost Medicines: The Use of Subscription Models to Treat Hepatitis C Using Direct-Acting Antivirals in the United States
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DOI：
10.1215/03616878-10041121
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发表时间：
2022-12-01
影响因子：
4.2
通讯作者：
Conti, Rena M.
中科院分区：
文献类型：
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作者：
Auty, Samantha G.;Griffith, Kevin N.;Conti, Rena M.
国家付款人可能会面临财政激励措施来限制高成本药物的使用。然而，限制获得高价值药物可能会对人口健康产生有害影响。直接作用抗病毒药物 (DAA) 自 2013 年起上市，可治愈丙型肝炎病毒 (HCV) 慢性感染。由于一个疗程的价格高达 90,000 美元，各州一直在努力确保医疗补助受益人和被监禁的丙肝病毒感染者能够获得 DAA。提前购买承诺 (APC)，其中付款人承诺以较低的价格购买一定数量的药物，为付款人提供激励以增加获得高价值药物的机会，同时也为公司提供有保证的收入。本文讨论了使用订阅模型（APC 的一种）来支持增加获得高价值 DAA 的机会以治疗 HCV。首先，作者提供了有关丙型肝炎病毒、其治疗以及处方药国家融资的背景信息。然后，他们审查了路易斯安那州和华盛顿州两个州 HCV 订阅模式的实施情况及其影响的早期证据。本文讨论了评估国家资助的订阅模式所面临的挑战，最后讨论了针对 DAA 和其他高价值、高成本药品的订阅模式的影响。
State payers may face financial incentives to restrict use of high-cost medications. Yet, restrictions on access to high-value medications may have deleterious effects on population health. Direct-acting antivirals (DAAs), available since 2013, can cure chronic infection with hepatitis C virus (HCV). With prices upward of $90,000 for a treatment course, states have struggled to ensure access to DAAs for Medicaid beneficiaries and the incarcerated, populations with a disproportionate share of HCV. Advance purchase commitments (APCs), wherein a payer commits to purchase a certain quantity of medications at lower prices, offer payers incentives to increase access to high-value medications while also offering companies guaranteed revenue. This article discusses the use of subscription models, a type of APC, to support increased access to high-value DAAs for treating HCV. First, the authors provide background information about HCV, its treatment, and state financing of prescription medications. They then review the implementation of HCV subscription models in two states, Louisiana and Washington, and the early evidence of their impact. The article discusses challenges to evaluating state-sponsored subscription models, and it con-cludes by discussing implications of subscription models that target DAAs and other high-value, high-cost medicines.