The new medicare drug benefit: formularies and their potential effects on access to medications.
The new medicare drug benefit: formularies and their potential effects on access to medications.
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新的医疗保险药物福利：处方集及其对药物获取的潜在影响。
DOI：
10.1111/j.1525-1497.2005.0110.x
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发表时间：
2005
影响因子：
5.7
通讯作者：
Keating,NancyL
中科院分区：
文献类型：
--
作者：
Huskamp,HaidenA;Keating,NancyL
在国会关于医疗保险D部分处方药福利的辩论中，很多注意力都集中在名义福利设计上。相对而言，人们很少关注计划如何运作的细节，比如药物处方集的设计。然而，处方集将成为控制成本的重要工具，并且在确定注册者获得药物和自付费用方面可能与名义福利设计一样重要。我们描述了D部分计划的激励措施，以及它们如何影响处方集的设计，然后为D部分处方集的实施提供建议。我们鼓励医疗保险和医疗补助服务中心（CMS）开发标准化工具，为医生和患者提供每个计划处方集上的承保药物的最新且易于访问的信息（可能通过中央网站），以及一套易于遵循的重新考虑和上诉程序。这些努力应该减少行政负担，更好地让医生帮助患者获得所需的药物。
During congressional debate over the Medicare Part D prescription drug benefit, much attention was focused on nominal benefit design. Relatively little attention was paid to details about how plans would operate, such as the design of drug formularies. Yet, formularies will be important tools for controlling costs, and may be as important as nominal benefit design in determining enrollees’ access to medications and out-of-pocket costs. We describe Part D plan incentives and how they may influence formulary design, and then provide recommendations for Part D formulary implementation. We encourage the Centers for Medicare & Medicaid Services (CMS) to develop standardized tools to provide physicians and patients with up-to-date and easily accessible information about covered drugs on each plan’s formulary (perhaps via a central website) and a national set of easy-to-follow procedures for reconsideration and appeals. Such efforts should reduce administrative burden and better allow physicians to help patients obtain needed medications.