Carroll Norman V
Virginia Commonwealth University School of Pharmacy, 410 North 12th Street, Box 980533, Richmond, VA 23298-0533, USA.
J Manag Care Pharm. 2008 Oct;14(8):768-79. doi: 10.18553/jmcp.2008.14.8.768.
Medicare Part D provides insurance coverage for prescription drugs to elderly and disabled consumers. Part D accounted for 24% of prescriptions dispensed by independent pharmacies in the first year of the program (2006). To date, the impact of Part D on independent pharmacies has been explored only in small, qualitative, or non-peer-reviewed studies.
To develop preliminary estimates of the impact of Part D on independent pharmacies' profitability.
A financial model was built to examine the impact of Part D on pharmacy profitability. A key input value was the gross margin percentage for Part D; the midpoint of estimates reported in the literature was used as the base-case input value. The remaining model inputs were derived from 2 non-peer-reviewed published sources: (a) the National Community Pharmacist Association (NCPA)'s survey of independent pharmacies, which provided financial data for the year prior to Part D implementation (2005); and (b) IMS Health national market research data, which provided information about changes in prescription drug utilization from 2005 to 2006. Model estimates represented a "typical" independent pharmacy, defined using mean values for financial measures in 2005 as reported by NCPA. The model examined the impact of Part D on the proportion of prescriptions reimbursed by other sources (private third-party insurance, Medicaid, and cash payments by patients); pharmacies' overall prescription gross margin; the number of Part D-induced prescriptions; the number of prescriptions lost to mail-order pharmacies; and net income before taxes. Key values and assumptions were subjected to one-way and probabilistic sensitivity analyses.
The model indicated that implementation of Part D resulted in a mean (SD) 22% (4%) decrease in net income before taxes. This change was primarily the result of an absolute 0.7% decline in the gross margin for all prescriptions. The lower overall gross margin resulted from lower reimbursement on Part D prescriptions. In the typical independent community pharmacy, Part D induced an increase in utilization of an estimated 427 prescriptions but 229 prescriptions were lost to mail-order pharmacies. The results were most sensitive to Part D reimbursement rates. Even under the most optimistic assumptions, Part D decreased net income. However, even under the least favorable assumptions, the typical independent pharmacy remained profitable.
Part D reduced the profitability of the typical independent pharmacy by an estimated mean (SD) 22% (4%) in 2006. This reduction resulted primarily from the lower Part D reimbursement rates.
医疗保险D部分为老年人和残疾消费者提供处方药保险。在该计划实施的第一年（2006年），D部分占独立药店所配处方药的24%。迄今为止，仅在小型、定性或非同行评审研究中探讨了D部分对独立药店的影响。
对D部分对独立药店盈利能力的影响进行初步估计。
构建一个财务模型来研究D部分对药店盈利能力的影响。一个关键输入值是D部分的毛利率；文献报道估计值的中点用作基准案例输入值。其余模型输入值来自2个非同行评审的已发表来源：（a）全国社区药剂师协会（NCPA）对独立药店的调查，该调查提供了D部分实施前一年（2005年）的财务数据；（b）艾美仕市场研究公司的全国市场研究数据，该数据提供了2005年至2006年处方药使用变化的信息。模型估计代表一家“典型”独立药店，使用NCPA报告的2005年财务指标平均值进行定义。该模型研究了D部分对其他来源（私人第三方保险、医疗补助和患者现金支付）报销的处方比例、药店总体处方毛利率、D部分引发的处方数量、流失到邮购药店的处方数量以及税前净收入的影响。关键值和假设进行了单向和概率敏感性分析。
该模型表明，D部分的实施导致税前净收入平均（标准差）下降22%（4%）。这一变化主要是由于所有处方的毛利率绝对下降了0.7%。总体毛利率较低是由于D部分处方的报销较低。在典型的独立社区药店中，D部分导致估计427张处方的使用量增加，但229张处方流失到邮购药店。结果对D部分的报销率最为敏感。即使在最乐观的假设下，D部分也会降低净收入。然而，即使在最不利的假设下，典型的独立药店仍保持盈利。
2006年，D部分使典型独立药店的盈利能力估计平均（标准差）降低了22%（4%）。这种下降主要是由于D部分较低的报销率。
